K. Stock (Halle)  

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2 Years  

N/A  

Head-Brain and brain nerves  

neoplastic  

2 year-old child with unspecific symptoms, which is typical for infratentorial tumors: Headache, vomiting, and in this case, (untypical) - double-vision.

Often, difficulties walking lead to the supposed diagnosis.

04/1997 ED (CT-Images)
04/1997 Surgery - subtotal removal of the tumor
1997-1999 intermitant Chemotherapy
1998 Diagnosis of the progressing tumor growth (MRI images 1 & 2)
11/99 After surgery of the reoccuring tumor, subtotal result.

At this time (2001) no proof of a progressing tumor growth (MRI images 3 & 4)  

Gliomas are tumors that arise from the ventricle's ependymal cells. These can be both supratentorial (about 30%) and infratentorial (about 70%) and also as "leaking metastases" in the spinal cord.

The tumors arise from ependymal cells and are mostly to be found near the ependyma, where they cause problems due to their growth. There is a hinderance of CSF circulation, and lead to typically an occluded hydrocephalus, which, in turn, cause the primary symptoms. The tumor cells can grow along nerves, vessels and in subarachnoid crevices into the brain's parynchema.

These tumors can be solid, but also soft, and can show cystic and knotty characteristics. Calcifications are seen in about 50-60% of cases.  

<- view CT 1

CT 1: non-contrast scan. Slight inhomogenic mass seen infratentorially. Slightly hyperdense with surrounding cerebral edema, hydrocephalus due to CSF hinderances.






<- view CT 2

CT 2: Following contrast media application: Areas of strong enhancement, left-sided calcifications.






<- view CT 3

CT 3: postoperative findings after subtotal resection of the tumor.







<- view MRI 1

MRI 1: (FLAIR-Sequence, transversal ) : 1 year after initial diagnosis. Progression of the remaining tumor mass.






<- view MRI 2

MRI 2:(T1-Sequence, coronal): Contrast media uptake in the remaining tumor.






<- view MRI 3

MRI 3: (FLAIR-Sequence, transversal): 4 years after initial diagnosis, 2 years after another surgical intervention. (Progression of the remaining tumor. Hyperintense in T2-weighted sequence).






<- view MRI 4

MRI 4: (T1-Sequence, coronal): Obvious contrast media uptake of the newly growing tumor.




 

Surgery / Histo  

1. Medulloblastoma as the most common tumor.
2. Astrocytomas of the brain stem
3. Rarer tumors: Gangliogliomas, Teratomas, Hemangioblastomas.  

Usually 2 age peaks: a) 1-5th year of life and b) in the 4th decade of life.
Sex preferences: M:F - 2:1
Ependymomas make up about 6-9% of the primary neoplasias of the CNS in children.
Within the group of infratentorial brain tumors, 9-15% are ependymomas.  

N/A  

N/A  

1. Medline:
Furie, D.M., J.M.Provenzale
Supratentorial ependymomas and subependymomas: CT and MR appearance.
J.Comput. assist. Tomogr. 19(1995) 518-526

2. Medline:
A.James Barkovich
Pediatric Neuroimaging 3rd Edition: 2000

3. Medline:
Kun LE, Kovner EH, Sanford RA.
Ependymomas in children.
Pediatr Neurosci 1988; 14:57-63  

Ependymoma, infratentorial, glioma, infratentorial ependymoma, child, childhood, pediatric radiology  

K Stock. Infratentorial ependymoma. PedRad [serial online] vol 1, no. 12.
URL: www.PedRad.info/?search=20011219131459