Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan.
Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan..
J Pak Med Assoc. 2024 Mar;74(3 (Supple-3)):S145-S151. doi: 10.47391/JPMA.S3.GNO-17.
This paper presents comprehensive consensus guidelines for the management of intracranial ependymoma, neoplasms arising from ependymal cells in the central nervous system's ventricular system, in low- and middleincome countries (LMICs). Acknowledging the distinct epidemiological patterns of ependymomas, notably their higher incidence in paediatric patients, and variable survival rates, these guidelines emphasize tailored management approaches for different age groups. An expert panel, comprising specialists in neuro-oncology, convened to address gaps in diagnosis and management within LMICs, considering the varying clinical presentation based on tumour size and location. Emphasizing surgical intervention as the cornerstone of treatment, the guidelines also address challenges such as intraoperative bleeding and tumour location impacting complete resection. The role of molecular subgrouping in stratifying treatment and predicting prognosis is highlighted, alongside a careful consideration of radiotherapy timing, dose, and volume based on risk factors. Chemotherapy's role, especially in paediatric cases, is explored. The paper synthesizes current research and expert opinions, including the need for standardisation, genetic testing, and exploration of less invasive treatment modalities, to address the unique healthcare infrastructure challenges in LMICs. The guidelines also emphasize multidisciplinary teams, aiming to bridge the care gap between high-income countries and LMICs, and improve survival rates and quality 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 strategies in diverse healthcare settings.
本文提出了针对中低收入国家（LMICs）颅内室管膜瘤（起源于中枢神经系统脑室系统室管膜细胞的肿瘤）管理的综合共识指南。鉴于室管膜瘤的独特流行病学模式，特别是其在儿科患者中的较高发病率和可变的生存率，这些指南强调了针对不同年龄组的定制管理方法。一个由神经肿瘤学专家组成的专家组，针对 LMICs 中诊断和管理方面的差距进行了会议讨论，考虑到基于肿瘤大小和位置的不同临床表现。强调手术干预作为治疗的基石，该指南还解决了术中出血和肿瘤位置影响完全切除等挑战。强调了分子亚组在分层治疗和预测预后方面的作用，同时还根据危险因素仔细考虑了放疗时机、剂量和体积。还探讨了化疗的作用，特别是在儿科病例中的作用。本文综合了当前的研究和专家意见，包括标准化、基因检测以及探索微创治疗方式的必要性，以应对 LMICs 中独特的医疗保健基础设施挑战。该指南还强调了多学科团队的作用，旨在弥合高收入国家和 LMICs 之间的护理差距，并提高颅内室管膜瘤患者的生存率和生活质量。本文为巴基斯坦及其他地区的临床医生、研究人员和政策制定者提供了有价值的资源，有助于在不同的医疗保健环境中制定基于证据的策略。
