Summary
Twenty patients with fourth ventricle ependymoma were treated surgically at our Neurosurgery Division between January 1976 und December 1990. Ependymoblastomas and mixed gliomas operated on in the same period have not been considered. A statistical analysis of our cases and a review of the largest published series show that favourable prognostic factors are: age over 16, post-operative radiotherapy to the posterior cranial fossa and a good Karnofsky performance status (KPS) after operation. The 5-year survival rate of patients under 16 was 20%, in comparison with 60% of adults (p=0.013). Post-operative radiotherapy to the posterior cranial fossa improved the survival markedly (5-year survival rate 68%, versus 18% without treatment; p=0.011). The differences of survival are also significant according to a multivariate analysis (p=0.038). Patients with a post-operative KPS over 70 had a 5 year survival rate of 61% as against 17% of the group with a worse clinical condition (p=0.032); the multivariate analysis confirmed also that this difference was significant (p=0.046). Pre-operative symptoms and signs, and KPS, histological grade and extent of surgical removal seem to influence the prognosis, even if the differences of survival are not statistically significant. The statistical relevance of postoperative residual tumour on CT or MRI was brought out on multivariate analysis (p=0.044).
Similar content being viewed by others
References
Barone BM, Elvidge AR (1970) Ependymomas. A clinical survey. J Neurosurg 33: 428–438
Becker LE, Halliday WC (1987) Central nervous system tumours of childhood. Perspect Pediatr Pathol 10: 85–134
Bloom HJG (1982) Intracranial tumours: response and resistance to therapeutic endeavors, 1970–1980. Int J Radiat Oncol Biol Phys 8: 1083–1113
Bock WJ, Clar HE, Weichert HC, Gerhard L (1981) Follow-up studies in the posterior fossa in children using computerized tomography. Neurochirurgia (Stuttg) 24: 2–5
Bouchard J, Pierce CB (1960) Radiation therapy in the management of neoplasms of the central nervous system with a special note in regard to children: twenty years experience, 1939–1958. AJR 84: 610–628
Chin HW, Maruyama Y, Markesbery W, Young AB (1982) Intracranial ependymoma. Results of radiotherapy at the University of Kentucky. Cancer 49: 2276–2280
Choux M (1983) Ependymomas of the posterior fossa in children. In: Amador LV (ed) Brain tumours in the young. Thomas, Springfield, Illinois, pp 526–545
Coulon RA, Till K (1977) Intracranial ependymomas in children. Childs Brain 3: 154–168
Cox DR (1972) Regression models and life tables. J R Stat Soc (B) 74: 187–220
Davis C, Symon L (1986) Posterior fossa ependymomas in adults. Acta Neurochir (Wien) 82: 115–117
Di Marco A, Campostrini F, Pradella R, Reggio M, Palazzi M, Grandinetti A, Garusi GF (1988) Postoperative irradiation of brain ependymomas: analysis of 33 cases. Acta Oncol 27: 261–267
Dohrmann GJ (1985) Ependymomas. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, Vol 1. McGraw-Hill, New York, pp 767–771
Ernestus RJ, Wilcke O, Schroder R (1989) Intracranial ependymomas: prognostic aspects. Neurosurg Rev 12: 157–163
Feigin I, Epstein F, Mangiardi J (1983) Extensive advanced maturation of medulloblastoma, astrocytoma and ependymoma. J Neurooncol 1: 95–108
Fokes EC jr, Earle KM (1969) Ependymomas: clinical and pathological aspects. J Neurosurg 30: 585–594
Garrett PG, Simpson WJK (1983) Ependymomas. Results of radiation treatment. Int J Radiat Oncol Biol Phys 9: 1121–1124
Geyer JR, Pendergast TW, Millstein JN (1988) Eight drugs in one day for children with brain tumours. J Clin Oncol 6: 996–1000
Goldwein JW, Leahy JM, Packer RJ, Sutton LN, Curran WJ, Rorke LB, Schut L, Littman PS, D'Angio GJ (1990) Intracranial ependymomas in children. Int J Radiat Oncol Biol Phys 19: 1497–1502
Guidetti B, Mercuri S, Vagnozzi R (1981) Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 54: 323–330
Goutelle A, Fisher G (1977) Les ependymomes intracraniens et intra-rachidiens. Neurochirurgie 23 [Suppl 1]: 1–6
Healey EA, Barnes PD, Kupsky WJ, Scott RM, Sallan SE, Black PML, Tarbell NJ (1991) The prognostic significance of postoperative residual tumour in ependymoma. Neurosurgery 28: 666–672
Heiskanen O, Lehtosalo J (1985) Surgery of cerebellar astrocytomas, ependymomas and medulloblastomas in children. Acta Neurochir (Wien) 78: 1–3
Houtteville JP (1970) Les épendymomas du IV∘ ventricule. Neurochirurgia (Stuttg) 13: 101–117
Ikezaki K, Matsushima T, Inoue T, Yokoyama N, Kaneko Y, Fukui M (1993) Correlation of microanatomical localization with postoperative survival in posterior fossa ependymomas. Neurosurgery 32: 38–44
Ilgren EB, Stiller CA, Hughes JT, Silberman D, Steckel N, Kaye A (1984) Ependymomas. A clinical and pathological study. Part I. Biologic features. Clin Neuropathol 3: 122–127
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481
Kim YH, Fayos JV (1977) Intracranial ependymomas. Radiology 124: 805–808
Koos WT, Miller MH (1971) Intracranial tumours in infants and children. Mosby, St. Louis, pp 331–334
Kricheff H, Becker M, Schneck SA, Taveras JM (1964) Intracranial ependymomas. A study of survival in 65 cases treated by surgery and irradiation. Am J Roentgenol 91: 167–175
Lejeune JP, Dhellemes P, Dupard T, Combelles G, Delandsheer JM (1987) Les épendymomes intracràniens. Experience de 86 cases. Neurochirurgie 33: 118–123
Liu HM, Boggs J, Kidd J (1976) Ependymomas in childhood. I. Histological survey and clinicopathological correlation. Childs Brain 2: 92–110
Lovin VA (1985) Chemotherapy of primary brain tumours. Neurol Clin 3: 855–866
Lyons MK, Kelly PJ (1991) Posterior fossa ependymomas: report of 30 cases and review of the literature. Neurosurgery 28: 659–665
Malis LI (1978) Intramedullary spinal cord tumours. Clin Neurosurg 25: 512–539
Marks JE, Adler SJ (1982) A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8: 37–43
Marsh JE, Adler SJ (1982) A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8: 37–43
Matson DD (1969) Tumours of the posterior fossa. In: Matson DD (ed) Neurosurgery in infancy and childhood, 2nd Ed. Thomas, Springfield, Illinois, pp 410–479
Mork SJ, Loken AC (1977) Ependymoma. A follow-up study of 101 cases. Cancer 40: 907–913
Nazar GB, Hoffman HJ, Becker LE, Jenkin D, Humphreys RP, Hendrick BE (1990) Infratentorial ependymomas on childhood: prognostic factors and treatment. J Neurosurg 72: 408–417
Olivecrona H (1987) The surgical treatment of intracranial tumours, In: Krenkel W, Olivecrona H, Tönnis W (eds) Handbuch der Neurochirurgie, Bd 4. Springer, Berlin Heidelberg New York Tokyo
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto K, Smith PG (1977) Design and analysis of randomizclinical trials required prolonged observations of each patient: II. Analysis examples. Br J Cancer 35: 1–39
Pierre-Kahn A, Hirsch JF, Roux FX, Renier D, Sainte-Rose C (1983) Intracranial ependymomas in childhood. Survival and functional results of 47 cases. Childs Brain 10: 145–156
Prince MR, Chew FS (1991) Ependymoma of the fourth ventricle. AJR 157: 1278
Read G (1984) The treatment of ependymomas of the brain or spinal canal by radiotherapy: a report of 79 cases. Clin Radiol 35: 163–166
Renaudin JW, Di Tullio MV, Brown WJ (1979) Seeding of intracranial ependymomas in children. Childs Brain 5: 408–412
Rorke LB, Gilles FH, Davis RL, Becker LE (1985) Revision of the World Health Organization classification of brain tumours for childhood brain tumours. Cancer 56: 1869–1886
Rubinstein LJ (1989) Clinical correlations of malignant ependymomas. In: Field WS (ed) Primary brain tumours: a review of histologic classification. Springer, Berlin Heidelberg New York Tokyo, pp 191–194
Russel DS, Rubinstein LJ (1977) Pathology of tumours of the nervous system, 4th Ed. Arnold, London, pp 203–226
Sagerman RH, Bagshaw MA, Hanbery J (1965) Consideration in the treatment of ependymoma. Radiology 84: 401–408
Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C (1984) Improved survival in cases of intracranial ependymoma after radiation therapy: late report and recommendations. J Neurosurg 59: 652–659
Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD (1987) Postoperative radiotherapy of intracranial ependymoma in pediatric and adult patients. Int J Radiat Oncol Biol Phys 13: 1457–1462
Shuman RM, Alvord EC, Leech RW (1975) The biology of childhood ependymomas. Arch Neurol 32: 731–739
Sonneland PRL, Scheithauer BW, Onofrio BM (1985) Myxopapillary ependymoma. A clinical and immunocytochemical study of 77 cases. Cancer 56: 883–893
Tomita T, McLone DG, Das L, Brand WN (1988) Benign ependymomas of the posterior fossa in childhood. Pediatr Neurosci 14: 277–285
Undjian S, Marinov M (1990) Intracranial ependymomas in children. Childs Nerv Syst 6: 131–134
Van Eys J, Chen T, Moore T (1981) Adjuvant chemotherapy for medulloblastoma and ependymoma using IV vincristine, intrathecal methotrexate, and intrathecal hydrocortisone: a South-west Oncology Group Study. Cancer Treat Rep 65: 681–684
Wallner KE, Wara WM, Sheline GE, Davis RL (1986) Intracranial ependymomas: results of treatment with partial or whole brain irradiation without spinal irradiation. Int J Radiat Oncol Biol Phys 12: 1937–1941
Wara WM (1985) Radiation therapy for brain tumors. Cancer 55: 2291–2295
West CR, Bruce DA, Duffner PK (1985) Ependymomas: factors in clinical and diagnostic staging. Cancer 56 [Suppl]: 1812–1816
Whitsker SJ, Bessel EM, Ashley SE, Bloom HJG, Bell Ba, Brada M (1991) Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 74: 720–728
Zee CS, Segall HD, Ahmadi J, Becker TS, McComb JG, Miller JH (1983) Computed tomography of posterior fossa ependymomas in childhood. Surg Neurol 20: 221–226
Zülch KJ (1986) Brain tumours: their biology and pathology, 3rd Ed. Springer, Berlin Heidelberg New York Tokyo, pp 258–276
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ferrante, L., Mastronardi, L., Schettini, G. et al. Fourth ventricle ependymomas. Acta neurochir 131, 67–73 (1994). https://doi.org/10.1007/BF01401455
Issue Date:
DOI: https://doi.org/10.1007/BF01401455