1. Management of Ependymomas George Jallo Division of Pediatric Neurosurgery Johns Hopkins University

2. Differential Diagnosis Ventricle Tumors EpendymomaAstrocytoma SubependymomaEpidermoid MedulloblastomaChoroid Plexus tumor

3. Posterior Fossa Tumors: Clinical Features 5-6% of intracranial tumors 69% occur in children 3 rd most common pediatric brain tumor 58% present in fourth ventricle

4. Pathology: Ependymomas

5. Imaging

6. Imaging of Ependymomas

7. Treatment Goal: Gross total resection Recurrence is common Adjuvant therapy –Radiotherapy beneficial –Chemotherapy: no proven benefit

8. Ependymomas: Survival vs. Age Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.

9. Survival Rate vs. Radical Resection Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26. Subtotal

10. Microanatomical Location vs. Resection of Tumor Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26. Subtotal

11. Microanatomical Location vs. Survival Rate Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.

12. Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.

13. Local Control vs. Treatment Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.

14. Prognostic Factors Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.

15. Conclusions Surgical resection is goal Adjuvant radiotherapy is helpful for residual disease if not resectable Role of chemotherapy still not determined