Childhood Intracranial Ependymoma Presenting as Cystic Supratentorial Brain Tumour

Approximately 50% of all childhood brain tumours arise in the infratentorial fossa and the most common tumours in this region of the brain are cerebellar astrocytomas, medulloblastomas, ependymomas, and brainstem gliomas [1]. Conversely in the suratentorial fossa, up to 20% of childhood tumours arise in the suprasellar region with craniopharyngiomas, visual pathway gliomas, and germinomas as the predominant tumours and contrasts with gliomas which constitute the majority of childhood cortical tumours with a predominance of low-grade tumours [1]. Ependymomas are rare gliomas and nearly half of the supratentorial ependymomas arise from the wall of the ventricles, while the rest appear to arise from the brain parenchyma [2, 3, 4]. The clinical characteristics and pathological description of the supratentorial ependymomas are not well defined in the literature and therefore still debated [5]. Despite aggressive therapy the attendant outcome for ependymomas has been poor, though the outcome are believed to be better for supratentorial ependymomas than infratentorial ependymomas, largely due to the possibility of performing a gross total resection in the supratentorial space [2]. Our case report highlights the challenges in the diagnosis and treatment of this rare supratentorial mass lesion which presented to us as a cystic, calcified supratentorial brain lesion in a child.