Further Outpatient Care
See the list below:
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Radiation therapy
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Chemotherapy
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Serial neuroimaging (MRI)
Further Inpatient Care
See the list below:
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Admit the patient for repeat surgery.
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Admit the patient for treatment of complications from surgery, radiotherapy, or chemotherapy.
Complications
See the list below:
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Hydrocephalus
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Paralysis
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Cranial nerve palsy
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Meningitis
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Bone marrow suppression
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Cognitive dysfunction
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Growth and developmental delay
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Hypothyroidism
Prognosis
See the list below:
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Gross total resection is the most important determinant of outcome, with progression-free survival rates of 70-80% after 5 years, compared to 35% for incomplete resection. [9]
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Postoperative radiation therapy improves survival, whereas results of chemotherapy are disappointing. [6]
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Age also strongly correlates with outcome. Usually, the younger the patient, the worse the prognosis.
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In addition to age, supratentorial tumor location is associated with a worse prognosis in adult ependymoma patients. Supratentorial location was also correlated with shorter progression-free survival than infratentorial location in a multicenter retrospective analysis. [10]
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Studies in which the current WHO classification criteria were applied reported the relationship between histological grade and outcome. Biomolecular studies have identified that gain of 1q25 and epidermal growth factor receptor (EGFR) overexpression correlate to poor prognosis, whereas low expression of nucleolin correlated with a favorable outcome. [11]
Patient Education
Refer the patient for psychosocial counseling.
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CT scan without contrast, axial view, demonstrates mixed but predominantly hyperdense tumor in the posterior fossa with severe obstructive hydrocephalus.
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CT scan with contrast, axial view shows moderately intense contrast enhancement (compare with the previous image).
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MRI, T2-weighted image, axial view, showing mixed (isodensity and hyperdensity) heterogenous nature of the tumor with some peritumoral edema.
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MRI, T1-weighted image, without contrast, sagittal view, showing the posterior fossa location, mixed (hypodensity and isodensity) signal intensity and tending to grow out of the fourth ventricle.
