Ependymoma

An ependymoma is a primary central nervous system (CNS) tumor. This means it begins in the brain or spinal cord.

What are the grades of ependymomas?

Ependymomas are grouped in three grades based on their characteristics. Within each grade, are different ependymoma subtypes. Molecular testing is used to help identify subtypes that are related to location and disease characteristics.

The Image on the right shows the MRI of an ependymoma in the spine.

Credit: NCI-CONNECT Staff

• Grade I ependymomas are low grade tumors. This means the tumor cells grow slowly. The subtypes include subependymoma and myxopapillary ependymoma. Both are more common in adults than in children. Myxopapillary tumors usually occur in the spine.

  
  

• Grade II ependymomas are low grade tumors and can occur in either the brain or the spine.

  
  

• Grade III ependymomas are malignant (cancerous). This means they are fast-growing tumors. The subtypes include anaplastic ependymomas. These most often occur in the brain, but can also occur in the spine.

  
  

Who is diagnosed with ependymomas?

Ependymomas occur in both children and adults. Ependymomas in the lower half of the brain are more common among children. Ependymomas in the spine are more common among adults. Ependymomas occur more often in males than females. They are most common in white and non-hispanic people.

What causes ependymomas?

The cause of ependymomas is not known.

Where do ependymomas form?

Ependymomas can form anywhere in the CNS. Ependymomas often occur near the ventricles in the brain and the central canal of the spinal cord. On rare occasions, ependymomas can form outside the CNS, such as in the ovaries. Ependymomas develop from ependymal cells (called radial glial cells). Ependymal cells are one of three types of glial cells that support the CNS.

Do ependymomas spread?

Ependymomas rarely spread outside the CNS. But ependymomas can spread to other areas of the CNS through cerebrospinal fluid (CSF).

What are symptoms of an ependymoma?

Symptoms related to an ependymoma depend on the tumor’s location. People with an ependymoma in the brain may have headaches, nausea, vomiting and dizziness. People with an ependymoma in the spine may have back pain, numbness and weakness in their arms, legs or trunk, problems with sexual, and urinary or bowel problems.

What are treatment options for ependymomas?

The first treatment for an ependymoma is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and to remove as much tumor as possible without causing more symptoms for the person. Microsurgery is usually used with fine microinstruments and using Computer Aided Image Guided Neuronavigation for accuracy and precision in tumor removal explains Dr Prem Pillay a US, Canadian trained Singapore Neurosurgeon (Cleveland Clinic-USA, MD Anderson Cancer Center USA, Hospital for Sick Children,Toronto).

After surgery, if there is residual or recurrent tumor there are other treatments for ependymomas. These treatments may include radiation including Stereotactic Radiotherapy or Radiosurgery, Medical therapy or clinical trials explains Dr Prem Pillay. Proton therapy is also another possible option. Clinical trials, with new medical therapy, targeted therapy, or immunotherapy, may also be available and can be a possible treatment option. Treatments are decided by the patient’s healthcare team based on the patient’s age, remaining tumor after surgery, tumor type, and tumor location.

Conclusion

Ependymomas, though rare, require prompt diagnosis and expert care to manage effectively. With advances in surgical techniques and radiotherapy, many patients achieve good outcomes. If you or your loved one are experiencing symptoms suggestive of a brain or spinal cord tumour, early evaluation is crucial. Visit the Singapore Brain Spine Nerves Center for comprehensive care tailored to your needs. Our specialists are here to support you at every step of your journey.