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Background: Myxopapillary ependymoma (MPE) is a rare variant of ependymoma. It has an indolent course in adults but in children it is aggressive. Because of its rarity there are no guidelines for management of metastatic MPE. Hence we report this case of MPE with drop metastasis treated with cranio-spinal irradiation (CSI) after subtotal resection (STR). Case Report: A 9 year old girl was evaluated elsewhere for low backache. MRI whole spine showed intra-dural mass compressing the conus and another lesion in the sacral spinal canal. She underwent STR. Post-operative histopathological examination was consistent with myxopapillary ependymoma. She was treated with CSI. Conclusion: Cranio spinal irradiation is essential for the treatment of metastatic MPE in pediatric population.

Background: Brainstem gliomas (BSGs) constitutes 10% of pediatric and 2% of adult brain tumors. Overall management of BSGs is complex due to lack of biopsy, location of the tumor making it inoperable and dosimetric constraints in RT delivery. We did a retrospective analysis on clinical outcomes of BSGs in our institute. Case Series: Seven cases of BSGs (5 adults and 2 pediatric) were included. Most common presenting symptom was weakness of limbs. Magnetic Resonance Imaging was the sole imaging modality. Biopsy was feasible in two patients. Median RT dose was 50 Gy. Two patients received concurrent temozolamide and one patient received adjuvant temozolamide. Median overall survival was 7.9 months. In our cohort adults had better survival than children. Conclusion: BSGs are distinct group of brain tumors. In most of the cases biopsy is not feasible and MRI is the current standard diagnostic imaging modality. Radiotherapy is the standard treatment options for BSGs.