Management of Infratentorial Ependymomas in Children

Initial Management at Presentation

• Surgery: Treatment of infratentorial ependymomas nearly always begins with surgery. Total resection, if achievable, is far superior to incomplete resection, since other treatments are rarely stabilizing and never curative.

Adjunctive Therapies

• Radiotherapy may prolong event-free survival: Radiotherapy after radical tumor resection lengthens event-free survival time in patients with infratentorial ependymomas of the posterior fossa.
• Chemotherapy used with infants: Chemotherapy can delay progression of infratentorial ependymomas and is used with infants who are too young for radiation.

Follow-up

• Office visits: Initially, frequent office visits are used to monitor for signs of developing hydrocephalus. After frequent initial visits postoperatively, subsequent visits are planned to coincide with scheduled MRIs.
• Postoperative imaging: A brain MRI with and without contrast is typically performed during the first 3 days after surgery and then 3, 6, 9, and 12 months after surgery. Subsequent scanning can be done every 6 months for the next 2 years and then yearly thereafter if there has been no recurrence.