Ependymomas belong to a group of tumours called gliomas. An ependymoma can start in different parts of the brain and the spine. Symptoms may include headaches, sickness (vomiting), personality changes or vision and balance problems.

To find out more about the tumour you will need different tests. You usually have an MRI scan or CT scan. You may have a lumbar puncture to check for cancer cells in the cerebrospinal fluid.

Some people have an operation to remove a small piece of tissue (biopsy) from the tumour. The tumour cells are examined to find out how slowly or quickly they may grow. Ependymomas often grow slowly.

Treatment depends on the tumour’s grade, its position and your health. Your specialist will talk to you about the best treatment for you and explain benefits and disadvantages.

The main treatments are surgery and radiotherapy and some people have both. Chemotherapy can be used if the tumour comes back. Your doctor may prescribe steroids to reduce your symptoms.

Treatments cause side effects. Your doctor will explain what to expect and how your side effects can be managed.

Brain tumours

This information describes what ependymomas are, their symptoms, tests and possible treatments. You should ideally read it with our information about brain tumours and spinal cord tumours.

The brain and spinal cord make up the central nervous system (CNS). The brain controls different functions of the body, how we think, feel, learn and move. The spinal cord is made up of nerves that run down the middle of the back (spine). Messages between the brain and other parts of the body travel through the spinal cord.

A tumour can be benign (not cancer) or malignant (cancerous). A benign brain tumour may cause problems as it grows because it can press on surrounding tissue. But it can’t spread to other parts of the brain.

Brain cross section detail
Brain cross section detail

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A malignant tumour can cause problems by growing into nearby tissues and may spread to other parts of the CNS. Slow-growing ependymomas may sometimes be called benign tumours.

Understanding ependymomas

Ependymomas are rare. They make up less than 4% of all CNS tumours in adults. They are a type of tumour called a glioma, which starts in the glial cells. Glial cells support and protect nerve cells in the brain (neurons). Ependymomas develop from a sub-type of glial cells called ependymal cells. These cells line the fluid-filled spaces in the brain (ventricles) and the centre of the spinal cord.

Ependymomas are often slow-growing tumours. They can develop in adults (usually adults under 45 years old) and also in children. This information is about ependymomas in adults. We have more information about brain tumours in children.

Ependymomas can develop in any part of the brain or spine. Occasionally, ependymomas that start in the brain can spread through the cerebrospinal fluid (CSF) to the spinal cord. The CSF fluid surrounds and protects the brain and spinal cord.

Causes of an ependymoma

As with most CNS tumours, it’s not known what causes ependymomas but research is going on to find out more. Previous radiation to the head or a genetic (hereditary) condition called type II neurofibromatosis may be risk factors.

We have more information about brain tumours and genetic factors.

Symptoms of an ependymoma

Because ependymomas are often slow-growing tumours, the symptoms usually develop slowly over many months. The symptoms will depend on whether it is in the spinal cord or the brain.

If the tumour is in the spine, pain in the neck or back is usually the first symptom. Other symptoms are numbness or weakness in the arms or in the legs, or problems with bladder control. We have more information about spinal tumours.

If the ependymoma is in the brain, symptoms will depend on the part of the brain that is affected by the tumour.

The first symptoms of ependymoma in the brain may be due to increased pressure in the brain (called raised intracranial pressure). This can happen because there is swelling around the tumour, or a build-up of cerebrospinal fluid (CSF) that surrounds and protects the brain and spinal cord. The symptoms of raised intracranial pressure are headaches, sickness (vomiting), problems with balance and with sight, and being confused.

Some other possible symptoms are:

  • headaches
  • changes in mood and personality
  • weakness in an arm or leg
  • problems with coordination and balance
  • seizures (fits).

Tests for ependymomas

Your doctors will need to find out as much as possible about the type, position and size of the tumour, so they can plan the best treatment for you. You will have a number of different tests.

The doctor will examine you and do checks on your nervous system. This includes checking your reflexes and the power and feeling in your arms and legs. They also shine a light at the back of your eye to check if the nerve (optic nerve) is swollen, which can be a sign of raised pressure in the brain. Your doctor will ask some questions to check your reasoning and memory. You will also have blood tests to check your general health and to see how well your kidneys and liver are working.

You will have a CT scan or MRI scan to find out the exact position and size of the tumour.

MRI scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. This test is painless and will take around 30 minutes. We have more detailed information about having an MRI scan.

CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.


Your doctor will explain if you need to have a biopsy (removing a small piece of the tumour). The biopsy and surgery to remove the tumour are sometimes done at the same time.

If you have a biopsy, it will usually be done under a general anaesthetic. The neuro (brain) surgeon makes a small hole in the skull and passes a fine needle through into the tumour. They remove a small sample of tissue which is examined to find out the type of cells the tumour is made up of.

Lumbar puncture

A lumbar puncture is sometimes carried out after ependymoma is diagnosed to look for tumour cells in the cerebrospinal fluid (CSF).

Your doctor uses a local anaesthetic to numb the lower part of your back and then passes a needle gently into the spine. They then take a small sample of CSF to be checked for tumour cells.

A lumbar puncture is usually done as an outpatient and it only takes a few minutes.

MRI scans can also show if the tumour is in the spinal cord.

Grading of ependymoma

Grading is about how the tumour cells look when they’re examined by a doctor (pathologist) under a microscope. The grade can give an idea of how quickly the tumour may grow. There are three grades of ependymoma.

The grades are:

  • Grade 1 (called myxopapillary ependymomas and subependymomas) usually grow slowly and are unlikely to come back if they are completely removed
  • Grade 2 (low-grade ependymoma) may grow more quickly than grade 1
  • Grade 3 (malignant or anaplastic ependymoma) are likely to grow faster than grades 1 or 2.

We have more information about grading brain tumours.

Treatment for an ependymoma

The main treatments for an ependymoma are surgery and radiotherapy. Your treatment will depend on the size and position of the tumour, and your general health.

Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and disadvantages of different treatment types. They will also explain the risks and side effects.

You and your doctor can decide on the treatments that are right for you. Make sure you have enough information and time to help you make treatment decisions.


Surgery is the main treatment for ependymoma. The aim is to get rid of all or as much of the tumour as possible.

If you have a low grade ependymoma that has been completely removed, you will not usually need any other treatment. If the surgeon cannot remove the tumour completely, they will usually advise you to have radiotherapy to get rid of any remaining cells.

Your surgeon will explain what your operation will involve. They will talk to you about the possible complications and risks.

It can take a while to recover after surgery so it’s important to take good care of yourself. Get plenty of rest, try to eat well and follow the advice given by your surgeon and specialist nurse.

Some people may need extra support to help with their recovery. This may be from a physiotherapist who can help you to improve your balance, walking or strength. Occupational therapists can provide equipment and help you become more independent.

Sometimes an operation is not possible. This may be because the position of the tumour makes it too difficult to reach and surgery would not be safe. Radiotherapy can be used instead.


Radiotherapy treatment uses high energy rays to destroy the tumour cells. Your cancer doctor (oncologist) will tell you how long your treatment will last and the type of radiotherapy you will have. Radiotherapy may be used:

  • on its own when surgery is not possible
  • after surgery for ependymomas that could not be completely removed 
  • after surgery and depending on the grade of the tumour, to help reduce the risk of it coming back, even when it has all been removed.

Radiotherapy makes you feel very tired and this can carry on for weeks or longer after it finishes. Try to get plenty of rest. The skin on your scalp or spine may become itchy and red or darker. You will lose the hair on in the area being treated. It usually grows back again after 2-3 months. Your nurse will give you advice about looking after the skin on your scalp and coping with hair loss.

Your cancer doctor and specialist nurse will talk to you about the immediate and possible long-term side effects of radiotherapy. Newer ways of giving radiotherapy aim to give a higher dose of radiotherapy to the tumour without damaging the surrounding normal brain.


Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. In adults with ependymoma, chemotherapy is not commonly used as part of first treatment. Doctors may suggest having chemotherapy if an ependymoma comes back.

We have more information about chemotherapy for brain tumours.


Steroids are drugs that reduce the swelling that surrounds a tumour. You may be given them before or after surgery and radiotherapy. They improve your symptoms and help you feel better.

Some of the side effects of steroids include: indigestion, weight gain, restlessness, agitation and sleep disturbance. Let your doctor or nurse know if these are causing problems or you notice any other effects. Taking steroids with food can help reduce indigestion.

It’s very important to take steroids exactly as your doctor has prescribed them.

Medicines for seizures

If you have seizures (fits) you will be given drugs called anticonvulsants to help prevent them.


You may not be allowed to drive for a period of time depending on the treatment you have had and if you have had any fits (seizures). Although this can be upsetting it’s important to follow the advice you are given. Your doctor will ask you to contact the Drivers and Vehicle Licensing Association (DVLA) if you live in England, Scotland or Wales. If you live in Northern Ireland you will need to contact the Driver and Vehicle Agency (DVA). It is your responsibility to contact the DVLA or DVA. Your doctor or nurse will explain what you need to do.