Ependymomas arise from the cells that line the ventricles (spinal fluid spaces within the brain) and the central canal of the spinal cord. In the brain, about 70% occur in children. In the spinal cord, however, about 96% occur in adults. The brain tumors tend to occur in the posterior fossa (the lower back portion of the brain). About 10% of the brain tumors will spread to the spinal cord through the spinal fluid. There are a number of varieties of ependymoma recognized by the World Health Organization. The papillary ependymoma (the most common) occurs in the brain and spinal cord. The myxopapillary ependymoma occurs only at the bottom of the spine. The subependymoma is a common finding at autopsy and a rare cause of surgical intervention. Finally there is the anaplastic ependymoma, a more aggressive tumor.
SYMPTOMS
The most common symptoms related to ependymomas in the brain include headache, nausea and vomiting, balance problems and dizziness. Tumors in the brain can also cause hydrocephalus by blocking spinal fluid passages in the brain. In the spine, symptoms can include back pain, leg weakness, loss of sensation and trouble with control of bowel and bladder function.
DIAGNOSIS
A careful history and physical examination is the first step in diagnosis. An MRI scan without and with intravenous contrast material is the best way to demonstrate tumors in the brain and the spine. In some cases, spinal fluid is sampled to test for the presence of tumor cells.
TREATMENT
The usual treatment is surgery to remove the tumor whether it is located in the brain or the spine. Depending on the particulars of the case, radiation therapy and/or chemotherapy might be necessary. There are a number of experimental trials available for select patients.