Treatment of Newly Diagnosed WHO Grade II–III Cerebral Ependymoma with CSF or Spinal Dissemination in Children

This protocol applies to children presenting with a new diagnosis of intracranial WHO grade II or III ependymoma in whom cerebrospinal fluid (CSF) analysis or spinal imaging reveals dissemination at the time of diagnosis.

Key clinical feature

The confirmation of CSF or spinal dissemination places this presentation in a distinct clinical category that directly shapes the treatment approach from the outset.

Initial management

First-line management begins with a surgical step. The goal of the procedure is to obtain a histological diagnosis, and the extent of surgical removal achieved is a critical variable in subsequent decision-making — the broadest safe resection is pursued whenever the patient's condition permits. The complete structured protocol specifies what follows.

Instant Access to Structured Evidence-Based Regimens

References

Resection is recommended to obtain a histological diagnosis and should be a gross total resection whenever feasible.

Craniospinal irradiation (CSI) is recommended in case of CSF or spinal dissemination with a boost on focal lesions with doses adapted to patient age.

DOI: 10.1093/neuonc/nox166

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