Ependymoma

Ependymoma is a type of tumor that can form in the brain or spinal cord. Ependymoma begins in the ependymal cells of the brain and spinal cord, which are located in the passageways through which the fluid that nourishes your brain (cerebrospinal fluid) flows.

Ependymoma can occur at any age, but is most common in young children. Children with ependymoma may have headaches and seizures. Ependymoma in adults is more likely to occur in the spinal cord and can cause weakness in the part of the body controlled by the nerves affected by the tumor.

The primary treatment for ependymoma is surgery. Additional treatments such as radiation therapy or chemotherapy may be recommended for more aggressive tumors or tumors that cannot be removed completely with surgery.

Diagnosis

Tests and procedures used to diagnose ependymoma include:

Neurological examination. During the neurological exam, your doctor will ask you about your child's signs and symptoms. It can check your child's vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas can provide clues about the part of your child's brain that may be affected by a brain tumor.

Imaging tests. Imaging tests can help doctors determine the location and size of a brain tumor. MRI is often used to diagnose brain tumors and may be used in conjunction with specialized MRI imaging such as magnetic resonance angiography. Because ependymoma can occur in both the brain and spine, imaging tests should be used to create pictures of both regions when the diagnosis of ependymoma is suspected.

Removal of cerebrospinal fluid for testing (lumbar puncture). Also called a spinal tap, this procedure involves inserting a needle between two bones in the lower spine to draw fluid around the spinal cord. The fluid is tested to look for tumor cells or other abnormalities.

Based on your child's test results, the doctor may suspect ependymoma and recommend surgery to remove the tumor. After removal, the tumor cells will be tested in a laboratory to confirm the diagnosis. Special tests are used to identify cell types and aggression levels that the doctor can use to guide treatment decisions.

Treatment

Ependymoma treatment options include:

Surgery to remove the ependymoma. Neurosurgeons (neurosurgeons) work to remove as much of the ependymoma as possible. The goal is to remove the entire tumor, but sometimes the ependymoma is located near sensitive brain or spinal cord tissue, making this very risky.

If the entire tumor is removed during surgery, your child may not need any additional treatment. If some tumor remains, the neurosurgeon may recommend another surgery to try to remove the rest of the tumor. Additional treatments, such as radiation therapy, may be recommended for more aggressive tumors or if the entire tumor cannot be removed.

Radiation therapy. Radiation therapy uses high-energy rays such as X-rays or protons to kill cancer cells. During radiation therapy, your child lies on a table while a machine moves around him and directs the rays to specific points in the brain.

Radiation therapy may be recommended after surgery to help prevent more aggressive tumors from recurring, or if neurosurgeons cannot completely remove the tumor.

Special techniques can help ensure that the treatment delivers radiation to the tumor cells and preserves as much surrounding healthy tissue as possible. Conformal radiation therapy, intensity modulated radiation therapy, and proton therapy are types of radiation therapy that allow doctors to deliver radiation carefully and precisely.

Radiosurgery. Technically a type of radiation and not an operation, stereotactic radiosurgery focuses multiple beams of radiation at precise points to kill tumor cells. Radiosurgery is sometimes used when an ependymoma recurs after surgery and radiation.

Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy is not very effective for most cases of ependymoma. The role of chemotherapy is still largely experimental and reserved for certain conditions, such as tumor regrowth despite surgery and radiation.