tailieunhanh - Manual of neurologic therapeutics - part 3

1. Poor prognostic factors: age younger than 2 years, incomplete resection, supratentorial location, duration of symptoms less than 1 month, and anaplastic histology. 2. The 5-year survival after complete resection and radiotherapy is 70% to 87% compared to 30% to 40% for partially resection; overall 10-year survival of 50%. 3. In children, fourth-ventricle tumors clinically more aggressive. 4. Anaplastic ependymoma has a 12% 5-year survival. 5. Subependymoma is indolent and often does not require treatment. 6. The prognosis for ependymoblastoma is poor with death within 1 year of surgery. DIAGNOSIS Location 1. Infratentorial in 60% of cases. 2. Most frequently in fourth. | 1. Poor prognostic factors age younger than 2 years incomplete resection supratentorial location duration of symptoms less than 1 month and anaplastic histology. 2. The 5-year survival after complete resection and radiotherapy is 70 to 87 compared to 30 to 40 for partially resection overall 10-year survival of 50 . 3. In children fourth-ventricle tumors clinically more aggressive. 4. Anaplastic ependymoma has a 12 5-year survival. 5. Subependymoma is indolent and often does not require treatment. 6. The prognosis for ependymoblastoma is poor with death within 1 year of surgery. DIAGNOSIS Location 1. Infratentorial in 60 of cases. 2. Most frequently in fourth ventricle 70 lateral ventricles 20 and cauda equina 10 . 3. In adults commonly occurs in lumbosacral spinal cord and filum terminale myxopapillary ependymoma . 4. May spread via CSF and seed other locations 12 . 5. Ependymoblastoma usually in cerebrum with frequent craniospinal metastasis. Clinical Presentation 1. Intracranial tumors produce symptoms due to obstruction of CSF flow headaches nausea vomiting visual disturbance ataxia dizziness hemiparesis and brainstem symptoms. 2. Spinal cord tumors present as a chronic progressive myelopathy or cauda equina syndrome see section on Spinal Cord Tu mo r . Diagnostic Tests 1. MRI shows a well-demarcated heterogenous enhancing intraventricular mass with frequent calcifications. Obstructive hydrocephalus and hemorrhage may be present. 2. Spinal MRI should be done to rule out neuraxis dissemination. Pathology 1. Grossly well circumscribed tan and soft tissue. 2. Microscopically densely cellular with ependymal rosettes blepharoplasts and perivascular pseudorosettes. 3. In cauda equina the myxopapillary form common. 4. Anaplastic ependymomas have malignant features such as mitotic activity pleomorphism and necrosis. 5. Ependymoblastoma has ependymoblastic rosettes in fields of undifferentiated cells. 6. Subependymoma is a benign lesion located within ventricles. Has .