Our patient underwent debulking of the tumor. A concavity in the brain stem was noted following removal of the vast majority of the tumor. The last remaining tumor adherent very densely to the brain stem was left in place so as to avoid injury to the brain stem. Patient is doing well 3 years after surgery without significant change in size of the residual tumor and remains neurologically intact.
Ependymomas account for 2-5% of all intracranial tumors in adults. There are four major types of ependymomas: myxopapillary ependymomas, subependymomas, ependymomas and anaplastic ependymomas. Supratentorial ependymomas are less common than the infratentorial ones. Infratentorial ependymomas are more common in pediatric patients.
The treatment of choice is gross total resection if possible, or debulking with possible adjuvant radiation therapy.