Ependymomas: Surgery

Abstract

Surgical treatment for ependymoma has been dramatically improved over the past 30 years, primarily related to fundamental innovations in surgery and medical technology. Surgery plays role in both the treatment of frequent associated hydrocephalus and the tumor itself. It provides tumor tissue aimed at obtaining the histological diagnosis and genetic profile of the tumor. It relieves the brainstem compression from the tumor and reduces the volume of local disease, as well. The extent of residual tumor is the most important prognostic factor regarding the outcome of children with ependymoma. However, the presence of extended tumors in both cerebellopontine cisterns, fourth ventricle floor, and sometimes the upper cervical spinal canal, especially in the youngest, should led the surgeon to staged surgeries to minimize the risk of neurological complications that may be due to removing the tumor from critical locations such as the low cranial nerves. The presence of significant neurological complications will not only result in significant disability of the patient but also in delay of further treatment of the patient with radiotherapy contributing to a worse prognosis.