2ND-LOOK SURGERY FOR INCOMPLETELY RESECTED 4TH VENTRICLE EPENDYMOMAS - TECHNICAL CASE-REPORT

OBJECTIVE AND IMPORTANCE: The prognosis for patients with ependymomas is related to the adequacy of surgical clearance. It is, however, ofte n not possible to obtain a macroscopically complete resection of tumor s arising in the posterior fossa. This may be because of the involveme nt of structures, the sacrifice of which would result in unacceptable morbidity, or because of metastatic lesions at diagnosis. For those pa tients in whom initial surgery was incomplete, elective second-look su rgery may allow more complete clearance of tumor. INTERVENTION: We hav e performed second-look surgery for fourth ventricle ependymomas in fi ve patients: two women, aged 26 and 27 years, and three male patients, aged 4 months, 19 months, and 18 years. The 19-month-old male patient underwent early second-look surgery without receiving any interim che motherapy. Second-look surgery on the other four patients was performe d after they had received chemotherapy. No additional major morbidity was associated with the subsequent surgery, which achieved macroscopic ally complete clearances in four of the five patients. Three of four p atients who underwent macroscopically complete resections were well, w ithout clinical or radiological evidence of recurrent tumor, at 23, 25 , and 34 months after their second operations. The 10-month-old patien t who underwent early second-look complete resection relapsed locally at 33 months after surgery. Complete resection was not possible in one patient who had progressive tumor 8 months after second-look surgery. CONCLUSION: For patients in whom complete excision of fourth ventricl e ependymomas is not possible al initial surgery, second-look procedur es may enable macroscopic clearance to be achieved with little morbidi ty. A larger study is needed to evaluate this approach to treatment.