Treatment of ependymoma abroad
Ependymoma or neuroepithelioma is an oncological illness of central nervous system when tumor is growing from the ependyma. This is a rare disease. Its incidence is 2 cases per million people a year.
Possible location of the tumor is central canal of the spinal cord or brain ventricles. Ependymoma can be found at any age including in children.
Causes of ependymoma
Ependymoma’s nature is poorly known. Probable risk factors of this illness are:
- Viral infections (herpes virus, papillomavirus of highly cancerous strains, SV40 virus)
- Chemical carcinogens
- Radiation exposure
Certain diseases can increase the risk of ependymoma and they include:
- Polyposis of the colon
- Recklinghausen's disease (neorifibromatosis)
- Multiple endocrine neoplasia syndrome
Ependymoma is found in children more often than in adults. Highest risk of this disease occuring is during first 2.5 years of life.
Symptoms of ependymoma
Clinical signs of ependymoma are mainly determined by its location.
Lateral ventricles in the brain are a number-one location of a tumor. Symptoms are absent on the beginning stages which later results in increased intracranial pressure.
High pressure can trigger:
- Disorientation in the space
Further, symptoms can be widen and include seizures, hallucinations, memory and mental disorders. A peculiar feature of ependymoma located in the lateral brain ventricles is intermittent course alternating between attacks and lucid intervals.
From time to time, cerebrospinal fluid outflow may be abnormal. This might provoke a unilateral hydrocephalus and hypertension crisis as a result of sharp rise of intracranial pressure. Crisis manifests itself by strong headache, vomiting, disturbance of consciousness including coma.
Fourth ventricle of cerebrum is a location of a tumor in 70% of pediatric cases.Except for high intracranial pressure, focal symptoms might appear. These signs are associated with the ependymoma pressure on the spinocerebellar tracts and on nuclei of cranial nerves.
Main symptoms are:
- Headache after the physical activity
- Tonic seizures
- Violation of cranial nerves function starting from fifth up to twelfth pair
Ependymoma of this location doesn’t disturb motor and sensory systems. Signs are absent or weakly manifested.
Tumor location is the spinalcord doesn’t bring any radicular pain. But sensitivity disorders can be observed in the innervations areas respective to the level of spinal nerves damage. Motor disorders can appear later.
Cauda equina or “horsetail”. Location of a tumor in the “horse tail” area (final zone of the spinal cord) can be manifested by the pain in buttock and possibly irradiate into the leg. Pain syndrome increases in the horizontal body position. First, pain is unilateral, and then it becomes bilateral. Motor disorders and urinary retention can appear later.
Diagnostics of ependymoma
The basis of ependymoma diagnostics is done by use of visualization techniques. A patient undergoes either computed tomography (CT) or magnetic resonance imaging (MRI) procedure.
Other diagnostics techniques are:
- Ultrasound is applied to detect the displacement of brain structures
- Electromyography and electroneurogram are used for assessment of movement disorders
- Lumbar puncture is applied to detect abnormal cells and measure intracranial pressure
- Ophthalmoscopy is used to determine the signs of intracranial hypertension
- Eye examination is used to check the vision which can worsen due to the damage of cerebrospinal fluid outflow
Visualization methods can help to find the tumor, though ependymoma must be differentiated from other malformations of central nervous system like astrocytoma and medulloblastoma. Unlike other tumor, ependymoma has cysts and calcifications. Doctors evaluate tumor state judging on where it is located and its ability to accumulate the contrasting agent.
Treatment of ependymoma abroad
The main treatment method of ependymoma is removal of the tumor during the surgery. Surgery can be total or subtotal. Total (complete) removal of a tumor helps to achieve much better results in the perspective of patients’ survival.
But it is not always possible to remove the tumor. If it has grown into the fourth ventricle of cerebrum or into the spinal cord, surgeon can perform only a subtotal resection of the malformation.
It is vital to undergo surgery in a good hospital (Germany, Switzerland, and other European countries). Surgery result are rated not only by length of patient’s life but also by the quality of his life.
There can be some post-surgery complications of the central nervous system like:
- Damage of the cranial nerves with loss of their functions
- Mutism (absence of speech in clear consciousness)
- Ataxia (incoordination)
- Movement disorders
Radiation therapy is effective enough for ependymoma treatment as tumor is highly sensitive to the radiation. Distant radiation therapy added to the surgery helps to lengthen patient’s life for few years.
Radiosurgery is applied to remove the residual tumor or as an alternative to the surgery if tumor cannot be removed. The purpose of radiosurgery is aiming radiation beams to the ependymoma tissues. This high-tech treatment technique helps to direct the beams as precisely as tenths of a millimeter. The better is the hospital equipment the more precise radiosurgery methods are used there.
To get best possible outcome of treatment with minimal risks for health a lot of patients go for treatment to Germany, Switzerland, or other countries with highly advanced healthcare system and developed medical travel.
Chemotherapy has low effect for ependymoma cure. Theyuseitonly as an additional treatment technique. Chemotherapy has poor effect on the patients’ survival.
Ependymoma - Prognosis
Depending on the age at the moment of diagnosis, five-year survival of a patient with ependymoma is:
- Up to 18 years old – 75%
- Up to 45 years old – 91%
- From 45 to 55 – 86%
- From 55 to 65 – 85%
Adults have more favourable prognosis than the children. Following prognostic factors are considered beneficial:
- Total tumor removal during the surgery
- Absence of cataplasia according to the results of histological test
- Tumor is located above cerebellar tentorium
Adverse factors are:
- Anaplastic ependymoma
- Subtotal tumor removal during the surgery
- Location of the malformation in postcranial fossa
The more beneficial factors patient has and the less of adverse factors are there, the better are the chances for recovery. In general, ependymoma responds to treatment very well and mortality rate is low compared to other tumors of the central nervous system.