| ependymal tumours are rare, accounting for 3% of all intracranial neoplasms. Intracranial ependymomas generally occur in children and young adults. Spinal cord ependymomas, however are seen more frequently in adult patients. Histologically, ependymomas have characteristic ependymal rosettes and perivascular pseudorosettes. So far there are no prospective randomized trials available. Ependymomas continue to generate considerable controversy regarding their rational clinical management. It is widely recognized that surgery is the mainstay of management. Despite its histological benignancy the cure for this disease has eluded us because of recurrences of these tumours. Further research into this tumour is vitally important for the treatment of these patients and improving the outcome.Objective: To review and sort out the clinical characteristics of patients withependymal tumours, a series of patients with Intracranial ependymomas and spinal cord ependymomas are analysed. To evaluate the current management strategies of patients with an ependymoma and to explore the prognostic factors those have a significant association with the outcome, so that can provide reference recommendations for the clinical management.Methods: eighty-five patients with histologically proven ependymal tumours between 1992-2004 were identified. Clinical data were collected. The tumours location, the patients'age, the histological features, imaging characteristics, surgical management and adjuvant therapy were studyed. The significantprognostic factors were tested for statistical significance.Results: The mean age was 27.6+18.1 years (range 2-63 years). Thirty-seven were infratentorial, 38 were supratentorial, and 10 were spinal cord ependymomas. These groups had mean ages of 22.1 + 17.8, 28.6+17.4, and 43.9+10.0 years, respectively, at the time of diagnosis. Thirty-one patients age^l5 years, while 54 patients age>15 years. Sixty (70.6%) and 25(29.4%) patients had low (WHO I -II) and high-grade(WHOHI) tumors, Respectively. Sixty-seven (78.8%) patients had gross total resection and 18(21.2%) patients had subtotal resection. The factors that found to have a statistical significance association with the outcome were the extent of the resection (x2=8.33, P<0.0\) and pathologic characteristics (X2=6.03, P<0.05).Conclusion: The degree of surgical resection appears to be one of the mostreproducible factors in determining outcome in intracranial ependymomas. A gross total resection of these tumors results in a good long-term outcome. While keeping minimal morbidity, every attempt should be made at the initial procedure to resect the tumour as completely as possible. Reoperation should be considered, if feasible, to remove residual disease. The real challenge of ependymoma surgery is the management of the attachment to the floor of the fourth ventricle, which is the site of origin. Newer techniques including ultrasonic aspiration, frameless neuronavigation, intraoperative evoked potential monitoring, intraoperative ultrasonography and endoscopic assisted techniques may allow for more extensive resection with less morbidity. Anaplastic ependymomas carry a much poorer prognosis. Spinal ependymomas are usually with a benign biological nature; anaplastic ependymomas are quite rare in the spinal cord. The gold standard in treatment protocol is gross-total resection without adjunctive radiation therapy.
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