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Supratentorial ependymomas in childhood: clinicopathological findings and prognosis
R I Ernestus1, O Wilcke, R Schröder
1Department of Neurosurgery, University of Cologne, Federal Republic of Germany.
Insights
Pediatric supratentorial ependymomas in hemispheres had better surgical outcomes and lower mortality than midline tumors. Complete resection is crucial for preventing recurrence, with adjuvant therapy offering limited benefits.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Tumor Biology
Background:
- Supratentorial ependymomas are a significant group of pediatric brain tumors.
- Tumor location (hemispheric vs. midline) may influence surgical resectability and patient outcomes.
- Understanding factors affecting recurrence and survival is critical for treatment planning.
Purpose of the Study:
- To analyze surgical outcomes, operative mortality, and recurrence rates of pediatric supratentorial ependymomas based on tumor location.
- To investigate the relationship between tumor grade, location, and patient survival.
- To evaluate the impact of surgical resection and adjuvant therapy on tumor recurrence.
Main Methods:
- Retrospective analysis of 29 pediatric supratentorial ependymomas operated on between 1951 and 1989.
- Categorization of tumors into hemispheric (18 cases) and midline (11 cases).
- Assessment of complete tumor removal, operative mortality, tumor grade, recurrence rates, and survival.
Main Results:
- Complete tumor removal was achieved in 15/18 hemispheric tumors versus 4/11 midline tumors.
- Operative mortality was higher for midline tumors (27%) compared to hemispheric tumors (11%).
- Recurrence-free survival at 5 years was 75% for grade 2 and 31% for grade 3 ependymomas, with an overall recurrence rate of 58%. Malignancy grade increased with distance from the ventricular level.
Conclusions:
- Hemispheric supratentorial ependymomas in children have better surgical outcomes and lower operative mortality than midline tumors.
- Total tumor resection is the most effective strategy for preventing recurrence.
- Postoperative irradiation may delay tumor growth in grade 2 ependymomas, but complete resection remains paramount.
Abstract:
Out of 29 supratentorial ependymomas in children under 10 years of age, operated on between 1951 and 1989, 18 were situated in the hemispheres and 11 in the midline. 15 of the 18 hemispheric tumours, but only 4 of the 11 intra- or paraventricular ependymomas allowed complete removal. The operative mortality within the observation period of nearly 40 years was 27% for tumours in the midline and 11% for those in the hemispheres. The grade of malignancy rose with increasing distance from the ventricular level. 5-year survival without recurrence was 75% in grade 2 and 31% in grade 3 ependymomas. The total rate of recurrence was 58%. New tumour growth can be delayed by postoperative irradiation, at least in grade 2 ependymomas. It can be prevented, if at all, only by total resection of the primary tumour.
