Management of fourth ventricular ependymomas / Hany Mohamed Ahmed ; Supervised Amr mahmoud Safwat , Ahmed Salah Eldin Hassan , Mohamed A. Elbeltagy

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Background: Ependymomas are rare neuroepithelial tumors which may arise anywhere along the ventricular system. Tumors arising in the 4th ventricle present unique challenges. Complete tumor resection favors prolonged survival, but may result in inadvertent injury of surrounding neural structures. Objective: to study clinical presentation, pathology, methods of investigations, operative techniques, complications of management of 4th ventricular ependymomas and eventually prognosis. Methods: This study was conducted upon forty patients with fourth ventricular ependymoma with variable ages at the time of diagnosis, admitted and managed at the Neurosurgery Department, at Kasr AL Ainy Hospital and Children{u2019}s Cancer Hospital-Egypt (CCHE-57357) between September 2015 and February 2017.Results: Total tumor excision was accomplished in 25 (62.5%) cases , near total resection in 5 (12.5%) cases, subtotal resection in 10(25%) cases. Pseudomenigocele occurred in 6 (15%) patients. Cerebellar mutism occurred in 4 (10%) patients. Bulbar manifestations was present in 5 (12%) cases.Tumor recurrence occurred in 4 (10%) patients during the follow-up period. Clinical outcome 3 weeks after surgery was excellent and good in 32 (80%) cases, fair and poor in 7 (17.5%) and there was one post operative mortality. Conclusion: Fourth ventricular ependymoma is a surgically treated disease. Extent of resection is considered the most important factor affecting prognosis of fourth ventricular ependymomas. Nevertheless, brain stem invasion and histopathological grade are also considered important factors affecting the outcome and prognosis

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