Management of Posterior Fossa Ependymoma in Paediatric Patients

Abu-Baih, Mohamed H.; Nanous, Waleed Z.; El-Sawy, Medhat M.; Moawad, Ahmed M.; El-Beltagy, Mohamed

doi:10.21608/mjmr.2024.331315.1825

Management of Posterior Fossa Ependymoma in Paediatric Patients

Articles in Press

Document Type : Original Article

Authors

¹ Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Minia University

² neurosurgery unit , department of surgery , Faculty of Medicine , Minia university , Minia , Egypt

³ department of neurosurgery, Faculty of medicine, Minia university

⁴ Department of neurosurgery, Faculty of Medicine, Cairo University

10.21608/mjmr.2024.331315.1825

Abstract

Posterior fossa ependymomas are formidable tumors characterized by their aggressive nature. Achieving complete surgical resection remains the most significant prognostic indicator, even though it carries the potential for adverse consequences.Our investigation aims to discuss our institution's experience with the surgical removal of juvenile fourth ventricle ependymoma tumors, focusing on the extent of the surgery and the resulting outcomes. From January 2022 to December 2023, a total of 20 children diagnosed with fourth ventricular ependymoma underwent surgery using the telovelar technique. An assessment was conducted to determine the extent of radicality, neurological result, comorbidities, and survival rates. A statistical analysis was conducted to identify the factors that are linked to the degree of radicality and the neurological result. Complete excision of the tumor was successfully accomplished in 16 individuals, representing 80% of the total. Every patient necessitated the diversion of CSF by means of a VP shunt. Two patients experienced cerebellar mutism, two patients (10%) experienced bulbar paralysis, and five patients exhibited tumor recurrence. Subtotal resection (p=0.020) and anaplastic ependymoma (p=0.038) were shown to be linked with a poor prognosis, as indicated by overall and progression-free survival rates.The telovelar technique offers a sufficient anatomical view of the fourth ventricle and enables early observation and safeguarding of its floor. It promotes sufficient thoroughness and is linked to a reduced occurrence of CM and other issues related to the method. Removing the posterior arch of the atlas can enhance the working angle, especially towards the front section of the fourth ventricle.

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