A-43 Pediatric Infratentorial Anaplastic Ependymoma: A Case Study

Abstract

Abstract Objective Ependymoma is the third most common malignant pediatric brain tumor and often presents posteriorly. Understanding of long-term outcomes of pediatric posterior fossa tumor and treatment is required to maximize developmental trajectory. This case illustrates cognitive correlates of pediatric posterior fossa tumor and treatment in an adolescent without cerebellar mutism or psychiatric co-morbidities. Repeated post-treatment assessments allowed for characterization of initial effects of treatment over time. Method The patient, diagnosed with an infratentorial anaplastic ependymoma at age 15, presented for initial neuropsychological evaluation status-post craniotomy, ventricular drain placement, posterior fossa tumor resection, radiotherapy, and chemotherapy. Recovery was complicated by cranial nerve palsies, dysphasia, and dysarthria. Repeat assessment was conducted 13 months later. Interim treatment included three cycles of maintenance chemotherapy. Aside from moderate dysarthria, the patient denied cognitive concerns each evaluation. Results Attention, working memory, planning, problem solving, language, reasoning, and motor speed/dexterity were within expectations at initial evaluation without deficits in academic or socioemotional functioning. Visual encoding/organization and processing speed were below expectations. Findings at follow-up revealed marked declines in bilateral motor speed and dexterity. Conclusion Weaknesses in visual organization and motor functioning are consistent with expected neurocognitive correlates of pediatric posterior fossa tumor and resection, particularly with cerebellar involvement. Additional motoric slowing is associated with white matter changes and often observed after cancer treatment. Longitudinal follow-up illustrated the potential for neurocognitive resilience in pediatric posterior fossa tumor treatment in the face of significant motor dysfunction. Nevertheless, late-effects of radiation and chemotherapy may manifest in early adulthood and must be monitored in pediatric patients.