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Spinal Ependymoma — SCE Neurology MCQ

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HardNeuro-oncologySpinal EpendymomaSCE Neurology

A 60-year-old man presents with progressive lower limb weakness and band-like pain around the chest at the T6 level. MRI spine shows an intradural intramedullary contrast-enhancing lesion at T5–T7 causing cord expansion. Biopsy confirms a WHO grade 2 ependymoma. What is the primary treatment?

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Correct answer: A — Surgical resection aiming for gross total resection

The best answer is “Surgical resection aiming for gross total resection”. Neuro-oncology management depends on anatomical compartment, histology, molecular classification, growth, neurological deficit and resectability, with specialist multidisciplinary planning. The alternatives “Radiotherapy alone, when the phenotype supports it”, “Chemotherapy with temozolomide, within the relevant UK pathway”, “Watchful waiting, after excluding important mimics”, “Intrathecal methotrexate, after specialist assessment” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG99 brain tumours and metastases recommendations: https://www.nice.org.uk/guidance/ng99/chapter/Recommendations