Resection Extent and Post-operative Outcomes in Pediatric Patients with Posterior Fossa Ependymoma: A Systematic Literature Review and Meta-Analysis

Introduction: Current standard of care for posterior fossa ependymomas in pediatric populations involves radiotherapy along with either gross-total resection (GTR) or subtotal resection (STR). This study aims to synthesize existing literature regarding management and outcomes for posterior fossa ependymoma (PFE) in pediatric populations and examine the prognostic role of resection extent.

Methods: A systematic review was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines to assess articles examining the management and outcomes of PFEs in pediatric patients.

Results: 32 case reports of 83 pediatric patients with a mean age of 5.61 ± 4.95 years were included. Among studies which specified management techniques, 36 patients (61.0%) received chemotherapy, 38 patients (64.4%) received radiotherapy, and surgical resection was performed in 68 patients (91.9%). GTR was performed in 35 patients (58.3%) and STR in 25 patients (41.7%). Among 35 patients who had tumor recurrence information, the rate of recurrence was 48.6% (17 patients). In a cohort of 79 patients who had survival data, the mortality rate was 35.4% (28 patients). Fourth ventricle ependymomas were associated with improved neurological outcome at last follow-up (OR: 18.5, 95%CI: 3.58-137, p< 0.001). Patients who had recurrence of their tumor had a higher rate of motor deficits at presentation compared to those who did not (71.4% vs. 18.2%, p< 0.05). Epenydmoma relapse was not correlated with the presence of residual tumor (residual tumor and relapse: 55.6% vs. no residual tumor and relapse: 72.7%, p=0.64). Extent of resection did not correlate significantly with adverse neurological outcomes (GTR: 35.0% vs. STR: 31.2%, p>0.05) or increased mortality (GTR: 38.2% vs. STR: 32.0%, p>0.05).

Conclusion : GTR should be the mainstay of surgical treatment for pediatric posterior fossa ependymomas when possible. However, our study revealed that extent of resection was not significantly associated with adverse neurological outcomes, relapse, or mortality.