Ependymomas are quite common among the nervous system. These tumors are localized in the tissues of the brain or spinal cord and are found mainly in young children, although it is also found in adult patients.
Concept and review of
pathology Ependymoma is a predominantly benign neuroectodermal tumor-like formation that originates from the ependymal layer lining the cerebrospinal central canal and cerebrospinal ventricles.
Some varieties of such formations are capable of spreading to other brain departments and parts by means of cerebrospinal fluid.
Ependymomas are distinguished by a rather caustic metastasis beyond the boundaries of the nervous system structures. If there is a relapse, the tumor usually develops in the same place or somewhere nearby.
Species of
Ependymomas are divided into two categories. The first is a malignant tumor, the second is benign.
Malignant ependymomas are classified into:
- Ependymoblastoma is the rarest form of oncology, formed from embryonic cell structures. Typical for children under 5 years of age, is characterized by negative predictions and low survival. Extremely malignant tumor;
- Anaplastic ependymomas -like formations are attributed to the third degree of malignancy. They are characterized by rapid metastasis and a large number of immature cells. Among all ependymomas, the anaplastic cerebrospinal form occurs in 25% of cases. Benign ependymomas are subdivided into several varieties:
- Ependymoglio or subendimoma - such tumors are formed from auxiliary nervous system cell structures, located mainly in the ventricular cerebral system. Such formations are characterized by a knotty form;
- Papillary ependymoma is a tumor of extramedullary type, which is characterized by the presence of plates, cords, partitions and villi. Such formations are localized mainly in the lumbosacral region;
- Mixopapillary ependymoma - develops in surrounding cerebrospinal structures. It is localized mainly in the lumbosacral zone( in the pony tail).It is characterized by melting of tissue structures, mucoid cyst formation, dystrophic changes in tissue in the affected area;
- True ependymoma - is found most often, differs by the presence of pathological cells around the vessels and canals.
In accordance with the nature of growth, intramedullary and extra-medullary ependyma are isolated. The extramedullary form occurs on the tissues surrounding the cerebrospinal and spinal structures, however, they do not germinate in them.
Intramedullary tumors can be located and germinate inside a spinal or cerebrospinal substance.
Causes of development of
It is not possible to unambiguously define the etiology of ependymoma.
In all clinical cases, the presence of the SV40 virus is detected in tumor cells, so specialists often associate ependyma with a similar virus, however, the viral nature of the tumor has not been conclusively proven.
Scientists point out several factors that can affect the development of ependymoma:
- Employment in harmful production, work under conditions of radiation exposure;
- Genetically determined predisposition to oncological processes;
- Presence in the anamnesis of oncogenic pathologies of a virus origin;
- Unfavorable and aggressive environmental conditions such as a polluted atmosphere, etc.
Symptoms of ependymoma of the brain and spinal cord
The clinical picture is caused by the localization of tumor formation.
If the tumor is located in the spinal cord, the patient observes such signs:
- Sensitivity to tactile touch, pain, cold or heat in the chest, upper or lower extremities( according to the lesion) is impaired. Violations can only spread to one side of the spine, or be bilateral. And usually these disorders develop from top to bottom;
- With the growth of the tumor, paralysis and paresis occur in the patient;
- No radicular syndrome;
- As the sensitivity and functionality of the limbs are impaired, features such as clumsiness, inability to engage in activities requiring the development of fine motor skills, gait changes, etc., may appear.
If the tumor forms in the brain, the patient is disturbed by manifestations such as:
- Paroxysmal headaches, often associated with physical stress, changing the posture, temperature conditions of the environment, and sometimes pain and even appear for no reason;
- Unreasonable vomiting, which can sometimes be caused by headaches;
- The patient assumes a forced position, in which the headaches will not be so intense;
- With a sharp turn of the neck or a change in the posture, the patient may become dizzy, ie, there is a syndrome of Bruns;
- Sometimes there are convulsive muscle contractions, similar to twitchings;
- When the tumor process is started, the symptoms are supplemented by mental disorders such as stupor, lethargy, psychoemotional inhibition, etc.
If ependymoma is located in the lateral cerebral vesicles, it can develop latent for a long time, manifested only in later stages, when associated pathologies like intracranial hypertension andAve
Such formulations with neglect of the tumor process are often accompanied by impairments of consciousness, memory and psyche, which manifests itself up. Ticity and lethargy, spatial disorientation, hallucinations, etc.
Diagnostics
survey involves the following procedures:
- Magnetic resonance imaging;
- CT;
- Angiographic examination - X-ray contrast diagnosis of blood vessels;
- Myelography is a contrast study of the pathways of CSF;
- Electroencephalography - the study of electrical brain activity;
- Ventriculoscopy - diagnosis of cerebral ventricles;
- Stereotactic biopsy with further cytology and histological diagnosis of the obtained biomaterial;
- Ultrasonography - the study is conducted in children with an open fontanel.
In addition, neurosurgical, neuro-ophthalmologic, neurological, neurotolaryngological narrow-profile consultations may be needed.
Treatment of ependymoma
The only correct method of treating ependymoma is a surgical procedure. With the implementation of complete resection, the favorable prognosis increases.
According to statistics, total removal is optimal only in a third of cases, as education is closely intertwined with vital organic structures.
Chemotherapy for ependymoma is relatively rare, because the effectiveness of such treatment has not been proven to date. Chemotherapy with drugs like Cisplatin or Carboplatin is prescribed after incomplete removal of education.
Survival prognosis
Survival is mainly affected by the degree of resection, with a successful complete resection providing the best possible prognosis.
The five-year survival rate after such an operation is about 69-80%. If the removal is incomplete, then after a while the tumor develops again.
The worst prognosis is observed in children younger than 4 years of age, because in such patients the tumor is localized mainly in the posterior fossa, which complicates access to the operation. The negative aspect is the presence of late consequences.
Tumors of this nature are quite common in children. Even with successful surgical treatment, postoperative complications may occur in the future.
Problems can include behavioral and hormonal changes, growth disorders or motor coordination, auditory or visual disturbances. In addition, such patients for life remain an increased risk of malignant oncology.
Therefore, children after the surgical treatment of ependymoma for a long time to observe the multidisciplinary specialists.
Video operations for removal of horse tail ependymoma: