Ependimoma of a brain
Ependimoma of a brain — a tumor from ependimalny fabric of ventricular system of a brain. It is clinically shown, first of all, by signs of the increased intra cranial pressure, and also an ataxy, violations from sight and hearing, convulsive attacks, violation of the speech and swallowing. Diagnostics is performed mainly by means of MRT of a brain, a spinal puncture, EEG, a histologic research. The basis of treatment is made by radical removal of an ependimoma with the subsequent beam or chemotherapy. At adults the stereotaksichesky radio surgery is applied.
Ependimoma of a brain
Ependimoma of a brain — TsNS tumor originating from ependimotsit. The last represent the epiteliopodobny cages forming an ependima — a thin epitelialny vystilka of cerebral ventricles and the central spinal channel. Ependimoma make up to 8% of all tumors of a brain, treat gliomas. Ependimoma meet at children's age more often, about 60% of patients are made by children of the first five years of life. On the prevalence the ependimoma of a brain takes the 3rd place among all cerebral tumors at children. At children's age it is more frequent, than at adults, its malignant options are observed.
Ependimoma of a brain is more often formed in a back cranial pole. In many cases it is characterized by the slow growth, lack of germination in surrounding cerebral fabrics. However in process of growth of a new growth it can cause mass effect — a brain sdavleniye. Metastasis of an ependimoma occurs mainly on likvorny ways and, as a rule, does not go beyond TsNS. Retrograde metastasises in a spinal cord are most often noted. Treatment ependimy is an urgent perspective of modern oncology, neurology and neurosurgery.
Brain ependimoma reasons
Researches allowed to find the SV40 virus which is in cages ependimy in an active state. However its role in development of a new growth is still not clear. Assume that the ependimoma of a brain arises in connection with influence of the tumors of onkogenny factors, general for the majority: chemical carcinogens, radioactive radiation, it is long the operating adverse environment (for example, hyper insolations), onkogenny viruses (a virus of herpes, papilloma of the person and so forth).
Besides, it is impossible to exclude participations of genetic factors in development ependimy. Combinations cerebral ependimy with a neurofibromatosis of Recklinghausen, a syndrome of multiple endocrine neoplaziya, a family polipoz of a thick gut are known.
According to modern classification distinguish 4 look ependimy, differing in degree of high quality and character of a course of tumoral process. The most good-quality is the miksopapillyarny ependimoma which is localized, mainly, in a spinal cord in a horse tail. Occurs generally at adults. Subependimoma differs in the slow good-quality growth, often an asymptomatic current and rather rare retsidivirovaniye. The classical ependimoma is observed most often. Can become the reason of occlusion of likvorny ways. Often recurs, over time it is capable to be transformed to an anaplastichesky ependimoma. The last makes about a quarter of all ependimy. Differs in the accelerated growth and metastasis what received synonymous names for: ependimoblastoma, malignant ependimoma, undifferentiated ependimoma.
Brain ependimoma symptoms
Ependimoma of a brain demonstrates symptoms of intra cranial hypertensia: the accruing headache, feeling of pressure in eyeballs, nausea, independent of meal, vomiting. Along with it at many patients irritability, some changes in habitual behavior, an ataxy — awkwardness and unsteadiness of walking, the diskoordination of movements complicating, first of all, small actions by hands including and the letter is observed. At children of school age noticeable deterioration in results of study is noted.
Above the specified symptoms are a consequence of a likvorno-gipertenzionny syndrome and are aggravated in process of increase of intra cranial pressure. If the ependimoma becomes an obstacle in a way of circulation of tserebrospinalny liquid and causes an obturation of likvorny ways, obturatsionny hydrocephaly develops. In a clinical picture it is shown by sharp increase of the available symptoms — the headache to become very intensive and is followed by repeated vomiting without simplification of a state. Convulsive attacks are possible.
The focal symptomatology accompanying a cerebral ependimoma varies according to a tumor location. The vestibular ataxy, doubling in eyes is characteristic of tumors of a back cranial pole. If the ependimoma of a brain settles down in the lower part of the IV ventricle, then relative deafness, a dizartriya, a cerebellar ataxy, a dysphagy are possible.
Diagnostics of an ependimoma of a brain
The expressed likvorno-gipertenzionny syndrome, emergence of other neurologic symptomatology or for the first time arisen are for the neurologist a reason for the direction of the patient on brain MPT or KT. MRT of a brain is more preferable as gives fuller information and allows to avoid beam loading, especially, when it is about inspection of the child. For children about one year the neyrosonografiya which is carried out through yet not closed fontanel can become a stage of primary diagnostics.
The electroencephalography, consultation of the ophthalmologist, direct oftalmoskopiya is in addition carried out. The lyumbalny puncture and a research of tserebrospinalny liquid is made for definition of prevalence of process on the spinal canal. Final verification of the diagnosis is possible only after morphological studying of the material of an ependimoma received intraoperatsionno or by a stereotaksichesky biopsy.
Treatment and forecast of an ependimoma of a brain
Optimum way of treatment of an ependimoma is its total removal. The frequent arrangement of a tumor in back a cranial pole causes certain difficulties of access to it which the neurosurgeon meets. If full removal of a tumor is impossible, operation can have palliative character. In such cases for improvement of outflow of tserebrospinalny liquid the shunting operation can be performed. For the purpose of reduction of probability of a recurrence of a cerebral ependimoma after surgical treatment radiation therapy is carried out. At children of early age whose brain is especially susceptible to radioactive radiation radiation therapy has to be reduced or replaced with chemotherapy. Treatment by cytostatics (tsisplatiny, karboplatiny) can be carried out after radiation therapy or instead of it. Its volume depends on character and prevalence of an epindimoma.
At adults destruction of a tumor is possible by method of stereotaksichesky radio surgery. Lately the Cyber-knife installation allowing to reach a high total dose of radiation of an ependimoma by a convergence on a tumor of the numerous bunches proceeding from different points of the device is more and more widely applied. However, in connection with big beam loading, this method is not recommended to children up to 14 years.
The Miksopapillyarny ependimoma and subepindimoma after their radical removal usually have the favorable forecast. In case of a classical ependimoma full removal works well not always. The new growth recurs, as a rule, in the place of the initial emergence. During successful removal 5-year survival is estimated at the level of 67-80%. The most negative outlook at an anaplastichesky ependimoma that is connected with its bystry distribution on likvorny ways. It should be noted that even after successfully performed treatment at patients in the subsequent various neurologic symptomatology, relative deafness, deterioration in sight can remain; at children the delay of mental development is possible.