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Intracranial ependymomas in children
Insights
This study on pediatric intracranial ependymomas found that supratentorial tumors had better outcomes than posterior fossa tumors. Improved survival for children with brain tumors depends on radical resection, radiotherapy, and chemotherapy.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Central nervous system tumors
Background:
- Ependymomas are common primary central nervous system tumors in children.
- Intracranial ependymomas present unique challenges in pediatric neurosurgery.
- Tumor location significantly impacts clinical presentation and treatment outcomes.
Purpose of the Study:
- To analyze the clinical characteristics, treatment outcomes, and survival rates of pediatric intracranial ependymomas.
- To compare outcomes between supratentorial and posterior fossa ependymomas in children.
- To identify prognostic factors for improving survival in pediatric ependymoma patients.
Main Methods:
- Retrospective analysis of 60 pediatric patients with intracranial ependymomas treated between 1964 and 1983.
- Categorization of tumors based on location (supratentorial vs. posterior fossa).
- Evaluation of surgical resection extent, postoperative mortality, and long-term survival rates.
Main Results:
- Posterior fossa ependymomas had shorter clinical evolution and higher incidence of localizing signs compared to supratentorial tumors.
- Radical resection rates were low for both locations (21.6% posterior fossa, 30.4% supratentorial).
- Postoperative mortality was higher for posterior fossa tumors (29.7%) than supratentorial (17.4%), with lower survival rates.
Conclusions:
- Supratentorial ependymomas demonstrated more favorable outcomes than posterior fossa ependymomas in this cohort.
- Radical tumor resection, combined with postoperative radiotherapy and chemotherapy, is crucial for improving outcomes.
- Further research is needed to optimize treatment strategies for pediatric intracranial ependymomas.
Abstract:
During a 20-year period (1964-1983), the authors managed 60 children with intracranial ependymomas. In 37 patients the tumors were located in the posterior cranial fossa, and in the remaining 23 they were supratentorial. The histological examination in 26 children revealed ependymoblastomas. The average duration of the clinical evolution was 4 months and 5 days in the supratentorial neoplasms and 3 months and 6 days in the subtentorial. Besides the intracranial hypertension, present in about 80% of the patients, specific localizing signs were seen in 70% of the children with subtentorial and in 40% of those with supratentorial tumors. Because of the growth pattern in posterior fossa ependymomas and despite the prevalence of histologically benign neoplasms, radical resection was accomplished in only 21.6% of the cases, as compared with 30.4% in supratentorial tumors. The postoperative mortality remains high: 29.7% in subtentorial tumors and 17.4% in supratentorial. The 1-year survival rate in subtentorial neoplasms was 70.3%, the 3-year survival 29.7%, and the 5-year survival 16.2%. The corresponding figures for supratentorial ependymomas more favorable: 82.6%, 43.5%, and 26.1%, respectively. The most important factors for improving the outcome at the present time appear to be as radical a resection as possible, supplemented with postoperative radiotherapy and chemotherapy.