Suboccipital Microsurgical Resection of Pediatric Ependymoma in the Foramen of Luschka: 2-Dimensional Operative Video.

Abstract

Ependymoma tumors are the third most common pediatric brain tumor. They can be found along the entirety of the neuroaxis, but pediatric ependymomas are most commonly found in the posterior fossa.1 We provide videographic2 description of an anatomic approach to the foramen of Luschka in a pediatric patient through a redo suboccipital craniotomy. In this surgical video, we present a 5-yr-old patient with previously resected ependymoma with recurrence in the foramen of Luschka. The patient underwent microsurgical gross total resection of the ependymoma by using a suboccipital approach. He tolerated the surgery well with an uneventful postoperative course followed by radiation therapy. Regardless of molecular subgroup, numerous studies have shown that near or gross total surgical resection followed by radiation therapy provides the greatest progression-free survival.1,3-6 Ependymomas of the posterior fossa, particularly recurrences or second look resections, can present a challenge to the surgeon because of scarred tissue and precarious location along the brainstem and cranial nerves. Although it has been our institution's observation that these tumors are often debulked, it has been our experience that with an appropriate approach by anatomic dissection, near and gross total resections can be achieved safely and confidently by the surgeon and thus maximize the patient's potential for progression-free survival. The legal guardian of the patient in the presented operative case has given consent for publication of this operative video, and the patient's family provided consent to the procedure.