Ependymomas belong to a group of tumours called gliomas. They can start in the brain or spinal cord. Symptoms may include headaches, feeling sick and vomiting, personality changes or vision and balance problems.

You will have different tests to find out more about the tumour, such as an MRI scan or CT scan. You may have a lumbar puncture to check for tumour 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 (the grade). Ependymomas are often slow-growing, low grade tumours.

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

The main treatments are surgery and sometimes radiotherapy. Chemotherapy is sometimes used if the tumour comes back. You may have other treatments to improve any symptoms. Your doctor will explain what side effects to expect and how they can be managed.

What are ependymomas?

Ependymomas are a rare type of tumour that usually starts in the brain or spinal cord. It’s best to read this with our general information about brain tumours and spinal cord tumours. This has more detail about tests and treatments.

This information is about ependymomas in adults. We also have information about brain tumours that is written for teens and young adults. If you need information about ependymomas in children you can contact the Children’s Cancer and Leukaemia Group.

Ependymomas belong to a group of tumours called gliomas. Gliomas are tumours that develop from the main supporting cells (glial cells) in the brain or spinal cord.

Different types of gliomas are named after the different types of glial cells. Ependymoma is a glioma that develops from a type of glial cell called ependymal cells. These cells line the fluid-filled spaces in the brain (ventricles) and the centre of the spinal cord.

Ependymomas can develop in any part of the brain or spine where there are ependymal cells. They can sometimes spread from where they started to other parts of the brain or spinal cord. They don’t spread to other parts of the body.

Grading ependymoma

Gliomas can be slow growing or fast growing. Your doctor may talk about the grade of the tumour. The grade describes how the tumour cells look when they are examined under a microscope.

Gliomas can be graded from 1 to 4:

  • Low grade tumours (grade 1 and 2) are slow growing.
  • High grade tumours (grade 3 and 4) grow faster.

Ependymomas are usually low grade (grade 1 or 2) slow growing tumours. But they can also be high grade (grade 3) tumours.

Your doctor may also describe ependymoma by the type:

  • myxopapillary ependymomas and subependymomas – grade 1 tumours
  • low-grade ependymoma – a grade 2 tumour
  • malignant or anaplastic ependymoma – a grade 3 tumour.

The grade and position of a glioma gives your doctors an idea of how the tumour may develop. This can help them plan your treatment.

Causes of ependymoma

The cause of ependymoma is not known, but research is being done to find out more.

In a small number of people, ependymoma is linked to an inherited (genetic) condition called neurofibromatosis type 2 (NF2).

Symptoms of ependymoma

Ependymomas are often slow-growing, so the symptoms may develop slowly over many months. The symptoms will depend on where the tumour is in the spinal cord or the brain.

If the tumour is in the spinal cord, the first symptom is usually pain in the neck or back. Other symptoms are numbness or weakness in the arms or in the legs, or problems with bladder control. The first symptoms of ependymoma in the brain may be due to increased pressure on the brain (called raised intracranial pressure). This can be caused by:

  • swelling around the tumour
  • the tumour itself
  • a build-up of the fluid that surrounds and protects the brain and spinal cord (cerebrospinal fluid).

Symptoms can include headaches, feeling or being sick, problems with balance and sight, and being confused.

A tumour in the brain can cause other symptoms depending on which part of the brain is affected. These can include:

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

Tests for ependymoma

Your doctors 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 on 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 an MRI scan or CT scan to find out the exact position and size of the tumour. You may also have a biopsy or a lumbar puncture.

Treating ependymoma

The main treatments for ependymoma are surgery and sometimes radiotherapy. Your treatment will depend on the size, grade 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 will have time to talk this through with them before you make any treatment decisions. You may be given a choice of treatment options. Let your specialist know if you need more information or time.


Surgery is the main treatment for ependymoma. The aim is to remove as much of the tumour as possible without damaging nearby areas of the brain or spine. Your surgeon will explain what your operation will involve. They will talk to you about the possible complications and risks. 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.

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 to you by your surgeon and specialist nurse.

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 may advise you to have radiotherapy to treat any remaining tumour cells.

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 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 to reduce the risk of ependymoma coming back.

Radiotherapy makes you feel very tired. This can carry on for weeks or longer after it finishes. Get plenty of rest but try to balance this with some gentle activity, such as short walks. This can help you to feel less tired.

The skin in the treated areas may become itchy and red or darker. You will lose the hair in the area being treated. This usually grows back again after 2-3 months.

Your cancer doctor and specialist nurse will talk to you about the side effects of radiotherapy and how they are managed. They will also explain the risk of late side effects. These are side effects that sometimes start months or years after radiotherapy.

Newer ways of giving radiotherapy may be used to treat ependymoma. These aim to give a higher dose of treatment to the tumour, without damaging nearby areas of the brain or spine. This can make treatment more effective and reduce side effects.


Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. This is rarely used to treat ependymoma in adults. Sometimes doctors may suggest having chemotherapy if an ependymoma comes back.


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

Some of the side effects of steroids include:

  • indigestion
  • weight gain
  • restlessness
  • agitation
  • 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 is important to take steroids exactly as your doctor has prescribed them.


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


You may not be allowed to drive for a period of time. Although this can be upsetting, it’s important to follow the advice you are given.

You will need 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). They will advise you of any restrictions on your right to drive:

  • The Drivers and Vehicle Licensing Agency (DVLA) has information about driving with a medical condition if you live in England, Scotland or Wales. Visit GOV.UK or call 0300 790 6806.
  • The Driver and Vehicle Agency (DVA) has information about driving with a medical condition if you live in Northern Ireland. Visit nidirect or call 0845 4024 000.

If you’re not sure what you should do, check with your cancer doctor or specialist nurse. They will explain things to you.


After your treatment has finished, you will have regular check-ups, tests and scans. These appointments are a good opportunity to talk to your doctor about any worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It can help to get support from family, friends, your specialist nurse or a support organisation. You can also talk things over with one of our cancer support specialists on 0808 808 00 00, Monday to Friday, 9am to 8pm.