gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Distinct clinical courses in pediatric ependymoma: Evaluation of a single institution cohort

Meeting Abstract

  • Daniela Pierscianek - Department of Neurosurgery, Essen, Deutschland
  • Elias Lemonas - Essen, Deutschland
  • Katharina Lischka - Neurochirurgische Klinik der Uniklinik Essen, Essen, Deutschland
  • Oliver M. Müller - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Nicolai El Hindy - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.07.02

doi: 10.3205/17dgnc217, urn:nbn:de:0183-17dgnc2170

Published: June 9, 2017

© 2017 Pierscianek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Ependymoma are the third most common brain tumor in pediatrics. The majority of tumors (60-70%) arise in the posterior fossa with a higher fraction of grade III tumors. Despite similar histopathological features the prognosis is strikingly heterogeneous ranging from early recurrences, multiple tumor operations and distant metastasis to completely progression-free clinical courses. In this study, we sought to assess the clinical course of supra- and infratentorial tumors and define factors associated with outcome parameters, as recurrence or metastasis.

Methods: Thirty-seven children with the diagnosis of Ependymoma were included between 1990 and 2016. Demographic parameters, treatment modalities (resection, chemo-, radiotherapy) and the clinical course (no. of operations, recurrences, distant metastasis) were assessed retrospectively using medical records. Fisher’s exact test and the two-sided t-test were applied for statistical analysis.

Results: In our patient cohort, tumor location was infratentorial in 73% of patients (N =27). In 64.9% of cases (N=24) an anaplastic ependymoma (grade III) was diagnosed. In 52.9 % of patients (N=18) a recurrence was diagnosed and 23.5% of patients had spinal or distant metastasis. The mortality was 36.7% until the time of data collection. Children with grade III tumors were significantly younger than children with grade II tumors (p=0.006). In our cohort, supra- and infratentorial tumors showed no differences concerning recurrence, death, no. of operations and spinal or distant metastasis. But for supratentorial tumors, there was an association between tumor grade and recurrence (p=0.012) and also between tumor grade and no. of operations (p=0.033). All children with supratentorial tumors grade III (N=6) experienced recurrence. Infratentorial tumors showed no association between tumor grade and recurrence. Time to progression was significantly shorter for infratentorial tumors compared to supratentorial tumors, independently of tumor grade (p=0.01). We did not detect an association between the extent of resection and recurrence or metastasis (p>0,5).

Conclusion: Supra- and infratentorial ependymoma show distinct clinical courses in pediatric patients. Especially for supratentorial tumors, histological tumor grading is associated with clinical outcome factors. In infratentorial tumors, factors other than tumor grading seem to influence clinical outcome. Further studies are necessary to assess prognostic factors, particularly in infratentorial tumors to stratify the risk profile.