Intracranial ependymomas in children

Abstract

During a 20-year period (1964-1983), the authors managed 60 children with intracranial ependymomas. In 37 patients the tumors were located in the posterior cranial fossa, and in the remaining 23 they were supratentorial. The histological examination in 26 children revealed ependymoblastomas. The average duration of the clinical evolution was 4 months and 5 days in the supratentorial neoplasms and 3 months and 6 days in the subtentorial. Besides the intracranial hypertension, present in about 80% of the patients, specific localizing signs were seen in 70% of the children with subtentorial and in 40% of those with supratentorial tumors. Because of the growth pattern in posterior fossa ependymomas and despite the prevalence of histologically benign neoplasms, radical resection was accomplished in only 21.6% of the cases, as compared with 30.4% in supratentorial tumors. The postoperative mortality remains high: 29.7% in subtentorial tumors and 17.4% in supratentorial. The 1-year survival rate in subtentorial neoplasms was 70.3%, the 3-year survival 29.7%, and the 5-year survival 16.2%. The corresponding figures for supratentorial ependymomas more favorable: 82.6%, 43.5%, and 26.1%, respectively. The most important factors for improving the outcome at the present time appear to be as radical a resection as possible, supplemented with postoperative radiotherapy and chemotherapy.

Factors Associated With Neurological Recovery of Brainstem Function Following Postoperative Conformal Radiation Therapy for Infratentorial Ependymoma

“…The next step is to determine the impact of these neurological deficits on parameters measuring functional outcomes and quality of life and then to find new ways to reduce surgical morbidity. Surgical morbidity rates in the range of 20 to 36% (9, 10) have previously been reported, and with technological improvements, morbidity rates in modern surgical practice have fallen. For tumors involving the posterior fossa, morbidity has been attributed to radical resection of IVth-ventricle tumors attached to the brainstem (11).…”

Prognostic Factors in Childhood Intracranial Ependymomas: The Role of Age and Tumor Location

“…Other series confirmed a poor outcome for posterior fossa ependymomas [12,21,26,39], suggesting that tumor location is important in limiting surgical removal and, consequently, affecting the outcome. In particular, considering fourth-ventricle ependymomas, which in our study accounted for 60% of the tumors, in some series most of the tumors seem to arise in the vestibular area or the lateral recess [8,43].…”

Treatment of ependymomas. Clinical and non-clinical factors influencing prognosis: a review

“…O ften the description of the extent of extirpation is based on the surgeon' s personal view, which is som etim es substantiated by postoperative neuro- The true extent of resection, as con® rm ed with postoperative M RI, should be correlated w ith survival, to use it as a prognostic factor. Som e authors report a better prognosis in a group of patients with a total resection of an intracranial ependym oma 7,12,20,24,27,29,68 or a spinal cord ependym oma. 16,22,39,40,45 Sutton et al 69 even found that the extent of surgical resection is a m ajor determ inant of ® nal outcom e in ependym omas.…”

“…7,23,27,29,46,59,63 C. Data obtained from series describing intracranial ependymomas in children only, including supra-and infratentorial ependymomas. 9,26,28,36,68,69,73 D. Data obtained from series describing spinal ependym omas in both adults and children. 38± 41,43,64,66,67,74,81± 82 cervical ® eld extension and local high dose irradiation with local ® elds.…”