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Supratentorial Ependymoma

A 9 month old child presented with seizures and irritability. MRI showed a large left medial temporal lesion with significant mass effect (Figure 1). Pre-operatively, possibility of glioma versus peendymoma was considered.
The child underwent left temporal craniotomy, amterior temporal lobectomy and tumor decompression. Intra-operatively, the tumor was soft, suckable, moderately vascular. Medial portion of tumor could not be dissected off the brain stem and was left behind. Child made an eventful recovery. He had mild right hemiparesis which recovered over few days.
His post-op scan showed adequate tumor decompression and reduction in mass effect. Histopathology was suggesstive of “Ependymoma Grade 2”

Figure 1a: Pre-op axial MRI shows large left medial temporal tumor

Figure 1b: Pre-op axial MRI showing left medial temporal mass lesion

Figure 2a: Post op CT scan with adequate resection of medial temporal tumor

Figure 2b: Post op CT scans with adequate tumor resection