Ependymoma Follow-up

Updated: Apr 14, 2015
  • Author: Jeffrey N Bruce, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
  • Print
Follow-up

Further Outpatient Care

See the list below:

  • 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.
Next:

Further Inpatient Care

See the list below:

  • 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.
Previous
Next:

Inpatient & Outpatient Medications

See the list below:

  • 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.
Previous
Next:

Transfer

See the list below:

  • 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.
Previous
Next:

Complications

See the list below:

  • 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.
Previous
Next:

Prognosis

See the list below:

  • Predictors of long-term survival include extent of resection made at surgery and amount of residual tumor on postoperative imaging. [39] Although lower WHO tumor grade, infratentorial location in children, absence of tumor invasion within the brainstem, absence of metastases, [40] improved performance status, and older age (for childhood ependymoma) have been associated with a survival advantage in isolated, retrospective series, [41] these factors are not significantly correlated with long-term survival. [30, 42]
  • Three recent series [43, 44, 40, 45, 46, 47, 48, 49] 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. [24]
Previous