Management of Ependymoma

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Management of Ependymoma

  1. 1. Management ofManagement of EpendymomasEpendymomas George JalloGeorge Jallo Division of Pediatric NeurosurgeryDivision of Pediatric Neurosurgery Johns Hopkins UniversityJohns Hopkins University
  2. 2. Differential Diagnosis VentricleDifferential Diagnosis Ventricle TumorsTumors EpendymomaEpendymoma AstrocytomaAstrocytoma SubependymomaSubependymoma EpidermoidEpidermoid MedulloblastomaMedulloblastoma Choroid PlexusChoroid Plexus tumortumor
  3. 3. Posterior Fossa Tumors: ClinicalPosterior Fossa Tumors: Clinical FeaturesFeatures 5-6% of intracranial tumors5-6% of intracranial tumors 69% occur in children69% occur in children 33rdrd most common pediatric brain tumormost common pediatric brain tumor 58% present in fourth ventricle58% present in fourth ventricle
  4. 4. Pathology: EpendymomasPathology: Ependymomas
  5. 5. ImagingImaging
  6. 6. Imaging of EpendymomasImaging of Ependymomas
  7. 7. TreatmentTreatment Goal: Gross total resectionGoal: Gross total resection Recurrence is commonRecurrence is common Adjuvant therapyAdjuvant therapy – Radiotherapy beneficialRadiotherapy beneficial – Chemotherapy: no proven benefitChemotherapy: no proven benefit
  8. 8. Ependymomas: Survival vs. AgeEpendymomas: Survival vs. Age Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.
  9. 9. Survival Rate vs. Radical ResectionSurvival Rate vs. Radical Resection Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26. Subtotal
  10. 10. Microanatomical Location vs.Microanatomical Location vs. Resection of TumorResection of Tumor Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26. Subtotal
  11. 11. Microanatomical Location vs. Survival RateMicroanatomical 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.
  12. 12. Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
  13. 13. Local Control vs. TreatmentLocal 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.
  14. 14. Prognostic FactorsPrognostic Factors Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
  15. 15. ConclusionsConclusions Surgical resection is goalSurgical resection is goal Adjuvant radiotherapy is helpful forAdjuvant radiotherapy is helpful for residual disease if not resectableresidual disease if not resectable Role of chemotherapy still not determinedRole of chemotherapy still not determined

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