Surgery for Ependymoma

Surgery is the treatment of choice for ependymomas.

After a brain tumor has been diagnosed on imaging, a biopsy will sometimes be taken to determine if the cells are cancerous or benign. A doctor will insert a long, thin needle into the growth to withdraw a few cells. The cells are then examined under a microscope to confirm the diagnosis. The medical team will then develop and recommend a treatment plan.

For most ependymomas, however, the goal of surgery is to resect (remove) the tumor. An ependymoma may be resected entirely or in part, depending on its features and location. Removing even part of the tumor can relieve symptoms caused by pressure on the brain or spine, or eliminate a blockage that is affecting the flow of cerebral spinal fluid. Depending on the type of ependymoma, especially if it is low grade, no further treatment may be necessary. Sometimes, especially with anaplastic ependymomas, further therapies are recommended following surgery, even if it appears the tumor was completely removed.

Radiation therapy can reduce the chance of recurrence in this type of aggressive ependymoma.

Chemotherapy may be beneficial in patients with high-grade ependymomas that recur, especially in the era of immunotherapy. Research is ongoing but chemotherapy will likely remain an important part of the treatment paradigm in patients with brain and spine metastases.

Advances in microsurgical techniques and high-quality imaging have greatly improved the prognosis for removal of ependymomas. At Weill Cornell Medicine, our neurosurgeons perform state-of-the-art procedures for a wide range of brain and spine conditions. We are fortunate to be a part of the NewYork-Presbyterian/Weill Cornell Medical Center, consistently ranked as one of the top hospitals in the United States, with one of the top neurosurgery programs in the nation.

Although traditional neurosurgery for ependymomas in the brain relied heavily on open surgery such as craniotomies and craniectomies (in which a portion of the skull is removed to allow the neurosurgeon access to the brain), today’s neurosurgeons are more likely to use whisper-thin tools that require smaller incisions and less trauma and that allow for faster recovery times.

Modern neurosurgery includes:

Microsurgery: Neurosurgeons today can operate using a microscope to visualize the tiniest of brain and spine structures.

Endoscopic neurosurgery: Neurosurgeons who specialize in endoscopic surgery use small, flexible, lighted tubes called endoscopes to visualize various parts of the brain, skull base, or spinal cord through small openings. The evolution of endoscopic neurosurgery has greatly advanced the treatment of cysts and tumors that form in the brain and spine.

Interventional neuroradiology (INR): Interventional neuroradiology is a relatively new specialty that combines advanced three-dimensional imaging techniques with minimally invasive catheter-based procedures. INR specialists may be radiologists or neurosurgeons who are specially trained in this advanced field. They can perform minimally invasive endoscopic techniques using high-tech imaging equipment to guide their work. (See more about our Interventional Neuroradiology Program.)

Stereotactic radiosurgery: Neurosurgeons use stereotactic radiosurgery for precise delivery of highly focused radiation that can pinpoint an ependymoma tumor or other target with little or no effect on normal surrounding tissue. It has been used with great success in the treatment of brain tumors and other conditions as an alternative to “open” surgery.  Neurosurgeons who specialize in stereotactic radiosurgery may perform procedures on a Linear Accelerator (LINAC), Gamma Knife, or CyberKnife. (See more about Stereotactic Radiosurgery at Weill Cornell Medicine.)

Intra-operative imaging: Advances in imaging techniques (such as CT, MRI, and PET scans) have allowed neurosurgeons to view highly detailed pictures in real time while they are operating.

Awake surgery and brain mapping: Sometimes, your neurosurgeon will need to map your brain during your procedure. This may entail you being awake for part of the procedure. Don’t worry – it will not be painful. The awake portion of the procedure is designed so that your surgeon can localize the areas of your brain critical for language function or movement. This allows your surgeon to remove the maximal amount of tumor while keeping you safe in the process. (See I Was Awake During My Brain Surgery for a patient’s view of what an awake craniotomy is like.)

Intraoperative Fluorescence: In many brain tumor operations, patients can now benefit from intraoperative fluorescence using 5-ALA technology. Using this novel treatment, surgeons have a new way of visualizing brain tumors separately from healthy brain tissue, thereby maximizing the degree of brain tumor removal.