Ependymomas are a distinct kind of glioma. Instead of arising from the support cells spread throughout the brain, they come from ependymal cells — the cells that line the brain's fluid-filled cavities (ventricles) and the central canal of the spinal cord.
Because of where these cells live, ependymomas tend to form in or near the ventricles or along the spinal cord. In children, they more often occur in the back of the brain (the posterior fossa), where they can block the flow of cerebrospinal fluid and cause a buildup of pressure (hydrocephalus). In adults, ependymomas are relatively more common in the spine. Symptoms depend on location and can include headaches, nausea, balance problems, or — for spinal tumors — back pain, weakness, or numbness.
Ependymomas occur in both children and adults, and they are graded and increasingly classified by molecular subgroup and location, which can affect how they behave and how they are treated. This is an active area of research, and modern classification recognizes several distinct ependymoma types.
The cornerstone of treatment is usually surgery, with the goal of removing as much of the tumor as safely possible — the completeness of removal is one of the most important factors in outcome. Radiation therapy is often used afterward depending on the tumor's grade, location, and how much was removed, and chemotherapy plays a role in certain situations, particularly in young children where doctors may try to delay radiation. Because spinal fluid can carry tumor cells, doctors sometimes image the entire brain and spine and examine the spinal fluid to check for spread.
Outlook varies widely by age, location, grade, molecular subgroup, and extent of removal, which is why ependymoma is best managed at centers experienced with these specific tumors.