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Diagnosing and Treating Ependymoma

Ependymoma is usually diagnosed after an individual notices symptoms and has been referred to a neurologist. A diagnosis of ependymoma begins with a thorough physical exam during which a neurologist will ask about symptoms and learn an individual’s history, including past illnesses and treatments, as well as family history. Reflexes, balance, coordination, and muscle strength will be checked for abnormalities, along with the individual’s hearing and vision.

If the physician suspects a brain tumor, imaging tests and other diagnostic tests will be ordered to confirm and provide details about the tumor type, size, location, and speed of growth.

A CT scan may be ordered to get a quick view to see whether there is a brain or spine tumor and whether it is causing a blockage of cerebrospinal fluid. A CT scan is a diagnostic imaging technique in which a computer reads X-rays to create a three-dimensional map of soft tissue or bone.

Usually, though, an MRI scan is used to create images of the brain or spine if an ependymoma tumor is suspected. MRI is a non-invasive imaging technology that uses radio waves and a magnetic field to produce three-dimensional detailed anatomical images without the use of radiation. Sometimes an MRI with contrast enhancement is performed; “contrast” is a special dye – gadolinium -- that is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. An MRI scan with contrast enhancement may reveal an ependymoma as a bright, well-defined mass. Cysts are commonly seen extending from the tumor; and changes in the spinal cord, like swelling, may also be seen.

Specialized MRI imaging, such as magnetic resonance angiography (MRA) may be used as well. An MRA is an MRI combined with an angiogram, which allows a radiologist and neurosurgeon to examine blood vessels around the tumor.

Up to about 15 percent of ependymomas spread, or metastasize, through the cerebrospinal fluid. The tumor cells may then grow independently in or along the spinal cord or (rarely) in other places in the brain. A spinal MRI scan and lumbar puncture (spinal tap) may be performed to determine whether the tumor has spread to the spine and/or spinal fluid. Ependymomas almost never spread outside the central nervous system.

A biopsy, which is the microscopic examination of tissue that a neurosurgeon removes, will confirm an exact diagnosis.

Treatments for Ependymoma
The decision on treatment for ependymoma is based on the type, grade, size, and location of the spine or brain tumor, whether it has spread, and the patient’s overall health and goals. Different treatments are often used in combination with one another and require a multidisciplinary team of experts: neurosurgeons, neuro-oncologists, radiation oncologists, neuropathologists, and other specialists.

Some grade I ependymoma tumors grow slowly, don't spread, and aren’t cancer. Still, any tumor in the brain or spine can cause symptoms by pressing on nearby healthy structures and may need to be removed, even if it is not malignant.