Neurologic Manifestations of Ependymoma

Neurologic Manifestations of Ependymoma

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Ependymomas are neoplasms of ependymal cells that occur throughout the entire neuraxis in association with the lining of the cerebral ventricles and central canal of the spinal cord.

Ependymomas occur most commonly in the intracranial and intraspinal areas, with lesions rarely occurring in the sacral area. Other unusual ectopic sites of ependymoma are the mediastinum, ovary, and broad ligament. In general, the anatomic location determines the pathophysiological manifestations of the tumor. Supratentorial tumors present with mass effect, focal neurological signs, and occasional obstruction of ventricular outflow. The relationship with the ventricular system is more apparent in tumors of the posterior fossa (mostly of the fourth ventricle), which usually present with obstructive hydrocephalus with or without signs of brain stem compression. See the images below.

United States

Ependymomas are infrequent tumors, representing 2-8% of all brain tumors. However, ependymomas are the third most common brain tumor in children (8-12%) with up to 30% occurring in children younger than 3 years. Half of the ependymomas occur in the first 2 decades of life; two-thirds are located in the posterior fossa (>90% are in the fourth ventricle). Interestingly, despite their overall low frequency, ependymomas are the most frequent neuroepithelial tumors of the spinal cord.

From the biological perspective, ependymomas do not usually proliferate rapidly, are not invasive, and usually do not metastasize. [1] The associated morbidity can mainly be accounted for by the local space-occupying effects of the tumor. However, children and adolescents, the oldest adult age group, cases diagnosed with anaplastic ependymoma, and/or tumor location in a brainstem site had lowest survival rates. [1] In unusual cases, the risk of sudden death from large intracranial ependymomas results from increased intracranial pressure secondary to obstructive hydrocephalus.

No race predilection is reported.

No sex predilection is reported.

Peak age at presentation ranges from 7 weeks to 16 years with a mean of 3.7 years. A second, lower peak age of presentation occurs in the third decade of life.

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Subrata Ghosh, MD, MBBS, MS Staff Physician, Division of Neurosurgery, St. Luke’s Episcopal Hospital, Texas Medical Center, Houston; Assistant Professor of Neurosurgery, Baylor College of Medicine

Subrata Ghosh, MD, MBBS, MS is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Texas Medical Association, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Draga Jichici, MD, FRCP, FAHA Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada

Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Medical Protective Association, Neurocritical Care Society, Canadian Critical Care Society, Canadian Critical Care Society, Canadian Neurocritical Care Society, Canadian Neurological Sciences Federation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge C Kattah, MD Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Rodrigo O Kuljis, MD Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine

Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience

Disclosure: Nothing to disclose.

Neurologic Manifestations of Ependymoma

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