gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Gross total resection without adjuvant radiotherapy leads to long-term progression free survival in adult posterior fossa ependymoma patients

Meeting Abstract

  • Sascha Marx - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
  • Ehab El Refaee - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
  • Soenke Langner - Institut für Radiologie und Neuroradiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
  • Henry W. S. Schroeder - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.13.02

doi: 10.3205/17dgnc248, urn:nbn:de:0183-17dgnc2483

Published: June 9, 2017

© 2017 Marx et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



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.