Ependymoma (4th ventricle)

Case contributed by Dr Katia Kaplan-List


65-year-old female with an 11-month history of intractable vomiting and nausea.

Patient Data

Age: 65
Gender: Female

ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org. 


There is a well-defined iso-T1, hyper-T2 uniformly enhancing mass at the inferior aspect of the fourth ventricle measuring 2 cm in craniocaudal by 1.4 cm in transverse by 1.5 cm in AP dimension.


Patient underwent suboccipital craniectomy and debulking of the fourth ventricular mass, biopsy showed the mass to be an ependymoa, WHO grade 2.

Case Discussion

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.

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