gms | German Medical Science

Objective: Gross total resection often is avoided in posterior fossa ependymoma surgery due to the fear of permanent neurological deficits after operation. However, the extent of resection is a major prognostic factor for progression free and overall survival. Independent of the extent of resection, it is a broad accordance for adjuvant radiotherapy.

Methods: The authors present a consecutive series of posterior fossa ependymoma surgeries in adult patients since 2001 in a single neurosurgical department. Special attention was paid to the intraoperative extent of resection as well as the MR-morphological and clinical long-term follow-up.

Results: 8 patients (2f, 6m, mean age 41.9 years, range from 29 to 56 years) underwent surgery for posterior fossa ependymoma. All tumors were WHO°II. Tumor adherence was found to be in the caudal rhomboid fossa (below the facial colliculus) in all patients. Gross total resection has been achieved in all patients (100%) without significant permanent neurological deficits after surgery. Dissection of the tumor adherence in the rhomboid fossa has done with the four-hand suction-irrigation technique. None of the patients got a further treatment (chemotherapy, radiation therapy, second surgery). In none of these patients, tumor recurrence was seen on MRI after a mean follow-up of 101 months (ranging from 13 to 181 months). 6 patients (75%) are fulltime worker. One patient (12.5%) died 7 years after surgery due to lung cancer. One patient (12.5%) suffered from a major stroke in the middle cerebral artery territory 9 years after surgery.

Conclusion: Long-term progression free survival in adult patients suffering from posterior fossa ependymoma is obtainable by gross total resection without adjuvant radio- or chemotherapy. By careful bimanual microsurgical dissection and avoidance of bipolar coagulation at the floor of the fourth ventricle, the risk for permanent neurological deficits after surgery is low.