Transcript Fourth Ventricle Tumors - Neurological Surgery Research

Management of
Ependymomas
George Jallo
Division of Pediatric Neurosurgery
Johns Hopkins University
Differential Diagnosis Ventricle
Tumors
Ependymoma
Astrocytoma
Subependymoma
Epidermoid
Medulloblastoma
Choroid Plexus
tumor
Posterior Fossa Tumors: Clinical
Features
5-6% of intracranial tumors
69% occur in children
3rd most common pediatric brain tumor
58% present in fourth ventricle
Pathology: Ependymomas
Imaging
Imaging of Ependymomas
Treatment
Goal: Gross total resection
Recurrence is common
Adjuvant therapy
– Radiotherapy beneficial
– Chemotherapy: no proven benefit
Ependymomas: Survival vs. Age
Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas:
Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.
Survival Rate vs. Radical Resection
Subtotal
Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas:
Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.
Microanatomical Location vs.
Resection of Tumor
Subtotal
Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas:
Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.
Microanatomical Location vs. Survival Rate
Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas:
Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.
Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa
Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
Local Control vs. Treatment
Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa
Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
Prognostic Factors
Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa
Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
Conclusions
Surgical resection is goal
Adjuvant radiotherapy is helpful for
residual disease if not resectable
Role of chemotherapy still not determined