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An ependymoma is an uncommon glial tumor, which arises from different parts of the neuroaxis. Considerable variation in presentation and survival in tumors in different locations after an optimum treatment indicates inherent molecular and genetic differences in tumorigenesis between them. A number of genetic aberrations have been identified to distinctly characterize different subgroups of ependymomas that include a posterior fossa tumor, a supratentorial tumor, and a pediatric tumor. These different groups have substantial genetic alterations, and also distinct demography, clinical characteristics, and prognosis. This article is intended to review the diverse molecular and genetic aberrations that may be helpful in prognostication and prediction of survival in patients suffering from an ependymoma.

Background : Neuroanesthesiologists are a highly biased group; so far the use of nitrous oxide in their patient population is concerned. We hypothesized that any adverse consequence with use of nitrous oxide should affect the patient so as to prolong his/her stay in the hospital. The primary aim of this preliminary trial was to evaluate if avoidance of nitrous oxide could decrease the duration of Intensive Care Unit (ICU) and hospital stay after elective surgery for supratentorial tumors. Patients and Methods : A total of 116 consecutive patients posted for elective craniotomy for various supratentorial tumors were enrolled between April 2008 and November 2009. Patients were randomly divided into Group I: Nitrous oxide - Isoflurane anesthesia (Nitrous oxide-based group) and Group II - Isoflurane anesthesia (Nitrous oxide-free group). Standard anesthesia protocol was followed for all the patients. Patients were assessed till discharge from hospital. Results : The median duration of ICU stay in the nitrous group and the nitrous-free group was 1 (1 - 11 days) day and 1 (1 - 3 days) day respectively (P = 0.67), whereas the mean duration of hospital stay in the nitrous group was 4 (2 - 16) days and the nitrous free group was 3 (2 - 9) days (P = 0.06). The postoperative complications in the two groups were comparable. Conclusion : From this preliminary study with a low statistical power, it appears that avoidance of nitrous oxide in one's practice may not affect the outcome in the neurosurgical patients. Further large systemic trials are needed to address this issue.

Majority of ependymomas are infratentorial and intraventricular. Supratentorial and purely cortical extraventricular ependymomas are extremely rare and only five cases were reported. We report a 15-year-old male with left frontal cortical ependymoma. He had gross total excision of the lesion and was not given radioptherapy.

Enterogenous cyst is extremely rare in the supratentorial compartment. Two adult patients with histologically variefied supratentorial entrogenous cyst are described. Light microscopy and immunohistochemistry examination revealed the endodermal origin of the cyst. Enterogenous cyst should be considered in the differential diagnosis of non-enhancing cyst in the supratentorial compartment. Total excision of the cyst wall should be done wherever feasible. Preventing spillage of the cyst contents during surgery is mandatory to avoid postoperative intractable seizures and craniospinal dissemination.