Which are the most common intraventricular neoplasms?
The most common intraventricular neoplasms are ependymomas, subependymomas, subependymal giant cell astrocytomas, central neurocytomas, choroid plexus papilloma, choroid plexus carcinoma, meningioma, and metastasis. Other intraventricular neoplasms are chordoid glioma, rosette-forming glioneuronal tumor.
From where do ependymomas arise?
Ependymomas originate from differentiated cells lining the surface of the cerebral ventricles and the central medullar canal.
In which compartment do most ependymomas in children occur?
Most ependymomas in children occur in the posterior fossa, with a preference for the fourth ventricle.
What are the clinical signs and symptoms of ependymomas?
Patients with ependymomas in the fourth ventricle may present with symptoms of increased intracranial pressure and hydrocephalus, due to obstruction, which may be associated with ataxia and paresis. Patients with supratentorial ependymomas usually have headaches, seizures, and focal neurologic deficits.
What are the radiological features of ependymomas?
On CT and MRI, ependymomas are usually heterogeneous masses reflecting the areas of calcification, hemorrhage, necrosis, and cystic degeneration. Calcification is common – 40-80% and Intratumoral hemorrhage may occur, which occasionally create a blood-fluid level. The soft-tissue component usually shows enhancement.
What is the treatment of choice for ependymomas?
Usually, the treatment of choice is surgical resection associated with radiotherapy.
Pre and post-contrast MRI shows a heterogeneously hyperintense signal lesion on the T2WI in the midline fourth ventricle, with intratumoral hemorrhage and internal cystic components. After the administration of contrast, the lesion shows irregular enhancement with non-enhancing cystic components — the mass results in obstructive supratentorial hydrocephalus, with mild dilatation of the third and lateral ventricles.