eMedicine Specialties > Oncology > Carcinomas of the Central and Peripheral Nervous System

Ependymoma: Follow-up

Author: Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Coauthor(s): David J Fusco, MD, Columbia University College of Physicians and Surgeons; Neil A Feldstein, MD, Director of Pediatric Neurosurgery, Department of Neurosurgery, Babies and Children's Hospital of New York, Assistant Professor, Departments of Clinical Neurosurgery and Pediatrics, Columbia-Presbyterian Medical Center, Columbia University; Benjamin Kennedy,, Columbia University College of Physicians and Surgeons
Contributor Information and Disclosures

Updated: Jan 26, 2009

Follow-up

Further Inpatient Care

  • Patients with ependymomas who undergo surgical resection typically spend the night after surgery in an intensive care unit followed by an inpatient stay of 3-5 days. The final length of stay depends on each patient's neurological condition as well as tumor location and extent of resection.
  • Postoperative antibiotics are usually continued for 24 hours, and deep vein thrombosis prophylaxis is continued until patients are ambulatory. Anticonvulsants are maintained at therapeutic levels throughout the inpatient stay for supratentorial ependymoma, while steroid dose is tailored to each patient's clinical status and gradually tapered pending improvement. Many patients benefit from occupational therapy and physical therapy/rehabilitation.
  • While patients are still in the hospital, they should undergo postoperative imaging to determine the extent of surgical resection. This is best evaluated within 3 days of surgery by a contrast-enhanced MRI of the brain because contrast enhancement during this period accurately reflects residual tumor.
  • In addition, patients should have an MRI of the entire spine with and without gadolinium to rule out seeding.
  • If not performed preoperatively, complete evaluations by consulting physicians, including a neurooncologist and radiation oncologist, should be considered.

Further Outpatient Care

  • Follow-up care with a rehabilitative medicine team is recommended for patients who sustain neurological deficits after spinal tumor resection.
  • Children with posterior fossa tumors must be monitored for signs of hydrocephalus, and all patients with supratentorial tumors should have serum levels of anticonvulsant drugs checked on a regular basis.

Inpatient & Outpatient Medications

  • For patients with supratentorial tumors, postoperative anticonvulsant medication is continued upon discharge.
  • Steroids are usually tapered in accordance with the patient's clinical status and degree of edema documented on postoperative imaging.

Transfer

  • At some institutions, transferring the patient to another facility may be necessary if the proper consultations cannot be obtained. In most cases, surgical resection can be performed on an urgent, but not emergent, basis.

Complications

  • In general, brain tumor resection has an overall mortality rate of 1-2%; 40% of patients remain healthy or have minimal deficits after surgery, 30% manifest no postoperative change relative to preoperative deficits, and 25% of patients sustain increased postoperative deficits that most often improve.
  • Children who undergo resection of a posterior fossa lesion are at risk for postoperative cerebellar mutism.
  • Nonspecific complications that can occur in any location of tumor include hemorrhage, infection, and worsening of neurological deficit.

Prognosis

  • Predictors of long-term survival include extent of resection made at surgery and amount of residual tumor on postoperative imaging.34 Although lower WHO tumor grade, infratentorial location in children, absence of tumor invasion within the brainstem, absence of metastases,35 improved performance status, and older age (for childhood ependymoma) have been associated with a survival advantage in isolated, retrospective series,36 these factors are not significantly correlated with long-term survival.25
  • Three recent series37,38,35,39,40,41,42,43 support the suggestion that the extent of resection is the most important predictor of outcome, independent of the histologic grade of the tumor. Patients with totally resected tumors, primarily of the posterior fossa, had an overall 5-year, progression-free survival rate of nearly 70% compared with 30-40% for those patients with partially resected tumors.
  • As noted in Mortality/Morbidity, intracranial ependymoma has an overall 5-year survival rate of approximately 50%, but the survival rate is significantly less for children with posterior fossa tumors.15
 
Acknowledgments

We wish to acknowledge previous contributions to this article by Paul C McCormick, MD, and Allen Waziri, MD.



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References
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Further Reading

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Keywords

ependymoma diagnosis, ependymoma treatment, ependymoma pictures, spinal cord tumors, cellular ependymoma, papillary ependymoma, clear cell ependymoma, anaplastic ependymoma, myxopapillary ependymoma, subependymoma, glial tumor, ependymal cell, CNS tumor, CNS malignancy, central nervous system tumor, central nervous system malignancy, brain cancer, spinal cancer

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Contributor Information and Disclosures

Author

Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Jeffrey N Bruce, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Neurological Surgeons, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Society for Neuro-Oncology, and Southwest Oncology Group
Disclosure: NIH Grant/research funds Other

Coauthor(s)

David J Fusco, MD, Columbia University College of Physicians and Surgeons
David J Fusco, MD is a member of the following medical societies: American Medical Association and Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Neil A Feldstein, MD, Director of Pediatric Neurosurgery, Department of Neurosurgery, Babies and Children's Hospital of New York, Assistant Professor, Departments of Clinical Neurosurgery and Pediatrics, Columbia-Presbyterian Medical Center, Columbia University
Neil A Feldstein, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Benjamin Kennedy,, Columbia University College of Physicians and Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert C Shepard, MD, FACP, Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International
Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy
Disclosure: Nothing to disclose.

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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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