Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 57, Num. 4, 2009, pp. 517-517

Neurology India, Vol. 57, No. 4, July-August, 2009, pp. 517

Correspondence

Author's reply

Yad Ram Yadav, Neha, S. K. Chandrakar¹

Neurosurgery unit and ¹Department of Pathology, NSCB Medical College, Apex Hospital and Research Centre Jabalpur MP, India.

Correspondence Address:Neurosurgery unit and Department of Pathology, NSCB Medical College, Apex Hospital and Research Centre Jabalpur MP, India.Yadavyr@yahoo.co.in

Date of Acceptance: 12-Aug-2009

Code Number: ni09152

DOI: 10.4103/0028-3886.55573

To the Editor,

We thank Dr. Moiyadi for his comments. ^[1] We agree partially with his concern that it is difficult to differentiate between pure cortical and extra-ventricular ependymoma and also regarding the need of adjuvant radiotherapy. ^[2]

Only computerized tomography (CT) scan was done in our case due to financial constraint. We agree that magnetic resonance imaging (MRI) could have rendered some additional information but MRI is not diagnostic and would not have helped to ascertain the site of origin of the tumor. Clinical presentation and CT findings in our patient favor cortical origin of the lesion. CT scan in our case clearly shows that the maximum diameter of the tumor was on the surface suggesting possible tumor origin from the cortex. Our patient presented with seizures and feature of raised intracranial pressure. He had minimal weakness (Grade 1-2/5). We presume a large subcortical (white matter) tumor of more than 4cms would have profound weakness. Delay in diagnosis (because of late medical consultation due to poor socioeconomic status of the patient) could be responsible for large size of tumor in our patient. Early seizures in cortical ependymoma and timely CT or MRI could have been the reasons of small size lesions in other reported cases. We agree that there would be a few more cases of cortical ependymoma which we had missed in our search.

We also agree that the pathological diagnosis needs to be interpreted in the light of the imaging findings. We think that a careful follow-up and timely postoperative imaging to detect tumor recurrence or growth is more important in deciding the need for adjuvant therapy. Adjuvant radiotherapy is indicated with tumor recurrence or when small residual tumor grows. We are following our patient regularly at three-month intervals. He was asymptomatic at 36 months follow-up. Follow-up CT done after 36 months of operation showed no changes from the postoperative CT scan. He is on antiepileptic drugs. We plan to follow him carefully and re-operate on him or give radiotherapy if tumor grows.

References

1.	Moiyadi A. Pure cortical supratentorial extraventricular ependymoma. Neurol India 2009;57: 516-7.  Back to cited text no. 1  [PUBMED]
2.	Yadav YR; Neha, Chandrakar SK. Pure cortical supratentorial extraventricular ependymoma. Neurol India 2009;57:213-5.  Back to cited text no. 2  [PUBMED]

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