On the Horizon for Supratentorial Ependymomas in Children

  • Improving surgical resection: Local control is one of the most important prognostic factors. Improvements in extent of surgical resection will include stereotactic/neuronavigational surgical techniques and intraoperative imaging to ensure completeness of resection; and intraoperative nerve monitoring, motor cortex mapping, and motor evoked potentials to reduce the likelihood of neurological deficits caused by surgery.
  • Improving radiation therapy: Conformal radiotherapy, which limits the highest dosage to the tumor site while reducing dosage to normal tissue, is the best modality at present. Optimal dosage has still to be determined so as to control tumor and yet reduce the side effects.
  • Future role of chemotherapy: Chemotherapy may be used to bridge the interval before a second resection, make the tumor more amenable to complete resection at the time of the second procedure, reduce the morbidity of the second resection, and bridge the interval required while preparing a neurologically impaired child for daily radiation.