Consensus guidelines for the management of intracranial ependymoma for low- and middle-income countries

Authors

  • Ahsan Ali Khan Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.
  • Muhammad Usman Khalid Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.
  • Mohammad Hamza Bajwa Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.
  • Izza Tahir The Aga Khan Medical College and University, Karachi, Pakistan.
  • Shahier Paracha The Aga Khan Medical College and University, Karachi, Pakistan.
  • Muhammad Shakir Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.
  • Bilal Mazhar Qureshi Department of Radiation Oncology, The Aga Khan University, Karachi, Pakistan.
  • Naureen Mushtaq Department of Paediatric Oncology, The Aga Khan University, Karachi, Pakistan.
  • Ahmed Gilani Department of Pathology, University of Colorado, Childrens Hospital Colorado, USA.
  • Pakistan Brain Tumour Consortium: (Authors list at the end of the supplement) +92 (021) 32226443
  • Syed Ather Enam. Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.

DOI:

https://doi.org/10.47391/JPMA.S3.GNO-17

Abstract

This paper presents comprehensive consensus guidelinesfor the management of intracranial ependymoma,neoplasms arising from ependymal cells in the centralnervous system's ventricular system, in low- and middleincomecountries (LMICs). Acknowledging the distinctepidemiological patterns of ependymomas, notably theirhigher incidence in paediatric patients, and variablesurvival rates, these guidelines emphasize tailoredmanagement approaches for different age groups. Anexpert panel, comprising specialists in neuro-oncology,convened to address gaps in diagnosis and managementwithin LMICs, considering the varying clinicalpresentation based on tumour size and location.Emphasizing surgical intervention as the cornerstone oftreatment, the guidelines also address challenges such asintraoperative bleeding and tumour location impactingcomplete resection. The role of molecular subgrouping instratifying treatment and predicting prognosis ishighlighted, alongside a careful consideration ofradiotherapy timing, dose, and volume based on riskfactors. Chemotherapy's role, especially in paediatriccases, is explored. The paper synthesizes current researchand expert opinions, including the need forstandardisation, genetic testing, and exploration of lessinvasive treatment modalities, to address the uniquehealthcare infrastructure challenges in LMICs. Theguidelines also emphasize multidisciplinary teams,aiming to bridge the care gap between high-incomecountries and LMICs, and improve survival rates andquality of life for patients with intracranial ependymoma.This article serves as a valuable resource for clinicians,researchers, and policymakers in Pakistan and beyond,facilitating the development of evidence-based strategiesin diverse healthcare settings.

Keywords: Nervous system, genetic, ependymoma,prognosis, ependymoma, surgery, radiotherapy.

Published

2024-06-09

How to Cite

Ahsan Ali Khan, Muhammad Usman Khalid, Mohammad Hamza Bajwa, Izza Tahir, Shahier Paracha, Muhammad Shakir, Bilal Mazhar Qureshi, Naureen Mushtaq, Ahmed Gilani, Pakistan Brain Tumour Consortium: (Authors list at the end of the supplement), & Syed Ather Enam. (2024). Consensus guidelines for the management of intracranial ependymoma for low- and middle-income countries. Journal of the Pakistan Medical Association, 74(3 (Supple), S145-S151. https://doi.org/10.47391/JPMA.S3.GNO-17

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