Here are key points:
The differential diagnosis from Hopkins neuroradiologist's most recent MRI report is: subependymoma (a rare subtype of ependymoma)
Tumor is measuring 5 by 6 mm - small - about "the size of an M & M."
Tumor is STABLE, at this time.
He is "confident" that tumor is not causing visual changes, given the area in the brain where it is and the size that it is (follow up w/ neurologist to explore sudden loss of vision).
MRI showed no signs of increased intercranial pressure.
Plan: Continued periodic scans - for the rest of my life - no surgery, no radiation at this time. Punting me back to Neurology Dept for visual follow-up. Still waiting to hear from JH and Pitt neurosurgeons.
AND ... FROM A PREVIOUS POST OF MINE ... in case you really like to read:
©2008 National Brain Tumor Foundation / Call Us for Support 1.800.934.CURE
Ependymal tumors begin in the ependyma, cells that line the passageways in the brain where cerebral spinal fluid (CSF) is produced and stored. Ependymomas are classified as either supratentorial (in the cerebral hemispheres) or infratentorial (in the back of the brain). Variations of this tumor type include subependymoma, subependymal giant-cell astrocytoma, and malignant ependymoma.
Characteristics • Usually localized to one area of the brain• Develops from cells that line the hollow cavities at the bottom of the brain and the canal containing the spinal cord • Can be slow growing or fast growing • May be located in the ventricles• May block the ventricles, causing hydrocephalus (water on the brain)• Sometimes extends to the spinal cord • Occurrence peaks at age five and again at age 34• Accounts for two percent of all brain tumors.
• Severe headaches• Nausea and vomiting• Difficulty walking• Fatigue and sleepiness• Problems with coordination• Neck pain or stiffness• Visual problems
The doctor will perform tests to determine if it has spread to the spinal cord. Surgery followed by radiation therapy is the usual course of treatment. A shunt may be needed to treat hydrocephalus caused by blockage of the ventricles.
The over-all five year survival rate is approximately 50%. Supratentorial epenedynomas, however, are generally more aggressive and have a poorer prognosis. Studies of prognostic characteristics in ependymomas are limited by the rarity of this tumor. Most studies are reports of single-institution experiences with few patients. The Mayo Clinic (Rochester, MN) experience with 80 patients represents one of the largest single-institution reviews and was published by Schild et al. Seventy of the patients had low-grade tumors and 10 had high-grade tumors. Prognostic factors favorably associated with survival included tumor grade, location, and histologic subtype (myxopapillary vs other ependymomas). Survival did appear to be somewhat improved in patients who had more of an extensive resection, but this was not found to be significant on univariate or multivariate analysis. All of the patients in this review did receive radiation postoperatively, and the 5-year and 10-year actuarial survival rates in low-grade tumors was 87% and 79%, respectively.
High-grade tumors did not fare as well with a 5-year survival rate of only 27%, with a high rate of local (80% recurrence at 5 years) and leptomeningeal (41% at 5 years) relapse. Guyotat et al. reported their experience with 34 adult patients. They found that anaplasia and location dictated outcome. None of the 17 patients with anaplastic ependymoma survived 5 years, whereas 90% of patients with fourth ventricle tumors (most grade 2) were alive at 10 years, and lateral ventricle tumors had a 10-year survival rate of 60%, whereas patients with third ventricle tumors had a 35% 10-year survival rate.
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