Extent of resection (EOR) is the most important modifiable prognostic variable for pediatric patients with posterior fossa ependymoma. An understanding of primary and recurrent ependymoma complications is essential to inform clinical decision-making for providers, patients, and families. In this study, the authors characterize postsurgical complications following resection of primary and recurrent pediatric posterior fossa ependymoma in a molecularly defined cohort.

The authors conducted a 20-year retrospective single-center review of pediatric patients undergoing resection of posterior fossa ependymoma at the Hospital for Sick Children in Toronto, Canada. Complications were dichotomized into major and minor groups; EOR was compared across complication categories. The association between complication occurrence with length of stay (LOS) and mortality was also assessed using multivariable regressions.

There were 60 patients with primary resection included, 41 (68%) of whom were alive at the time of data collection. Gross-total resection was achieved in 33 (58%) of 57 patients at primary resection. There were no 30-day mortality events following primary and recurrent ependymoma resection. Following primary resection, 6 patients (10%) had posterior fossa syndrome (PFS) and 36 (60%) developed cranial neuropathies, 56% of which recovered within 1 year. One patient (1.7%) required a tracheostomy and 9 patients (15%) required gastrostomy tubes. There were 14 ventriculoperitoneal shunts (23%) inserted for postoperative hydrocephalus. Among recurrent cases, there were 48 recurrent resections performed in 24 patients. Complications included new cranial neuropathy in 10 patients (21%), of which 5 neuropathies resolved within 1 year. There were no cases of PFS following resection of recurrent ependymoma. Gastrostomy tube insertion was required in 3 patients (6.3%), and 1 patient (2.0%) required a tracheostomy. Given the differences in the location of tumor recurrence, a direct comparison between primary and recurrent resection complications was not feasible. Following multivariate analysis adjusting for sex, age, molecular status, and EOR, occurrence of major complications was found to be associated with prolonged LOS but not mortality.

These results detail the spectrum of postsurgical morbidity following primary and recurrent posterior fossa ependymoma resection. The crude complication rate following resection of infratentorial recurrent ependymoma was lower than that of primary ependymoma, although a statistical comparison revealed no significant differences between the groups. These results should serve to inform providers of the morbidity profile following surgical management of posterior fossa ependymoma and inform perioperative counseling of patients and their families.

切除范围 (EOR) 是后颅窝室管膜瘤儿科患者最重要的可改变预后变量。了解原发性和复发性室管膜瘤并发症对于提供者、患者和家庭的临床决策至关重要。在这项研究中，作者在分子定义的队列中描述了原发性和复发性小儿后颅窝室管膜瘤切除术后并发症的特征。

作者对加拿大多伦多病童医院接受后颅窝室管膜瘤切除术的儿科患者进行了 20 年回顾性单中心审查。并发症分为主要组和次要组；对不同并发症类别的 EOR 进行了比较。还使用多变量回归评估了并发症发生率与住院时间（LOS）和死亡率之间的关联。

共有 60 名接受一期切除的患者，其中 41 名 (68%) 在数据收集时还活着。 57 例初次切除患者中，有 33 例 (58%) 实现了大体全切除。原发性和复发性室管膜瘤切除术后未发生 30 天死亡事件。初次切除后，6 名患者 (10%) 出现后颅窝综合征 (PFS)，36 名患者 (60%) 出现颅神经病变，其中 56% 在 1 年内康复。 1 名患者 (1.7%) 需要气管切开术，9 名患者 (15%) 需要胃造口管。因术后脑积水插入了 14 个脑室腹腔分流器（23%）。在复发病例中，24 例患者中有 48 例进行了复发切除。并发症包括 10 名患者 (21%) 出现新发颅神经病变，其中 5 名神经病变在 1 年内得到缓解。复发性室管膜瘤切除后无 PFS 病例。 3 名患者（6.3%）需要插入胃造口管，1 名患者（2.0%）需要气管造口术。鉴于肿瘤复发位置的差异，直接比较原发性和复发性切除并发症是不可行的。经过调整性别、年龄、分子状态和 EOR 的多变量分析后，发现主要并发症的发生与 LOS 延长相关，但与死亡率无关。

这些结果详细说明了原发性和复发性后颅窝室管膜瘤切除术后的发病率范围。幕下复发性室管膜瘤切除后的粗并发症发生率低于原发性室管膜瘤，但统计比较显示组间无显着差异。这些结果应有助于提供者了解后颅窝室管膜瘤手术治疗后的发病情况，并为患者及其家属提供围手术期咨询。