Management of The Posterior Cerebral Fossa Ependymomas

K Badache

doi:10.31579/2578-8868/158

Abstract

Background Posterior fossa brain ependymomas are one of the most devastating forms of human illnesses which are more common in children. Brainstem compression, herniation and death are the risks with tumours in this critical location. Patients and Methods: A retrospective study including 50 patients with posterior fossa ependymoma were performed at the Neurosurgery Department in Ait IDDIR University Hospital between the period of January 2005 and December 2015 . In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically.. All patients received the adjuvant treatment Results Out of 50 patients, 30 (60%) patients were males and 20 (40%) were females. The mean age was 24 years (ranged 5 months –47 years) ; we identified 29 (58%) children and 21 (42%) adults,. Ventriculo-peritoneal shunts were placed in all our patients, the total tumor excision was done to 35% and the partial tumor excision was done to 65% patients. The most common complications were as follows: Shunt malfunction : 4% , operative cavity hematoma 6%, CSF fistula 4%, deterioration of Cerebellar syndrome 6%, Cerebellar Mutism 2%, Mixed nerves palsy 4% and early post operative deaths 10%. Tumor architecture was classified as classic (Grade II) in 35 (70%) cases and anaplastic (Grade III) in 13(26%) cases. Adjuvant treatment regimens following resection included radiation therapy only (72%) for 36 patients including children above and adults and chemotherapy only (36%) for 9 children below 4 years and 9 recurrent tumors. During follow-up period, recurrence occurred in 27% 11patients out of 41patients .Five patients died (10%). Conclusion The surgical treatment of posterior fossa tumours still represents a challenge for neurosurgeons, Radical surgery with preservation of vital structures is the treatment of choice in patients with Posterior Cerebral Fossa ependymomas.. Our experience shows the accepted results, complications and surgical outcome in relation to previous clinical studies.

Highlights

Ependymoma represents the third most common childhood malignancy of the brain, accounting for approximately 10% of all pediatric brain malignancies. [1] the most common site of presentation is the posterior fossa. [1] Standard therapy involves maximal safe resection, followed by radiation therapy (RT). [2] Patients and Methods: Study design A retrospective clinical cohort study of 50 patients with posterior fossa ependymoma were performed, and they underwent open surgical excision with ventriculo-peritoneal (V-P) shunt
Clinical manifestations of ependymoma vary widely according to the location.The most frequent clinical manifestations found were Intracranial hypertension syndrome (87%) and static and kinetic cerebellar syndrome (10%)
For the Surgical outcome of this study: the Ventriculo-peritoneal shunts were placed in all our patients, the total tumor excision was done to 35% and the partial tumor excision was done to 65% patients

Summary

Introduction

Ependymoma represents the third most common childhood malignancy of the brain, accounting for approximately 10% of all pediatric brain malignancies. [1] the most common site of presentation is the posterior fossa. [1] Standard therapy involves maximal safe resection, followed by radiation therapy (RT). [2] Patients and Methods: Study design A retrospective clinical cohort study of 50 patients with posterior fossa ependymoma were performed, and they underwent open surgical excision with ventriculo-peritoneal (V-P) shunt. Ependymoma represents the third most common childhood malignancy of the brain, accounting for approximately 10% of all pediatric brain malignancies. [1] the most common site of presentation is the posterior fossa. [2] Patients and Methods: Study design A retrospective clinical cohort study of 50 patients with posterior fossa ependymoma were performed, and they underwent open surgical excision with ventriculo-peritoneal (V-P) shunt. Preoperative work-up All patients underwent routine physical examination; they received a thorough neurological evaluation. A special neuro-surgical sheet was applied in all cases included in the study to cover all suspects needed. CT as well as MRI, with and without contrast enhancement, was done for all cases before surgery as shown in (Figure 1)

Results

Discussion

Conclusion