CEREBELLAR PONTINE ANGLE EPENDYMOMA IN INFANTS

We discuss the surgical approach used for and outcome in II infants (l ess than or equal to 3 years) who were treated at our institution for ependymomas arising in the cerebellar-pontine (C-P) angle. The median age of the group was 19 months (range: 6-26 months). Of these 11 patie nts, the initial surgery for 8 was performed at our center and achieve d a gross total resection (GTR) in 4 patients and a subtotal resection (STR) in the remaining 4. The 3 patients who had tumor debulking perf ormed elsewhere were subsequently referred to our institution and had definitive surgery after receiving 3-4 courses of chemotherapy; one of these children had a GTR, whereas the remaining 2 had an STR. During the immediate postoperative period, 9 patients had cranial nerve defic its that necessitated placement of a tracheostomy and a gastrostomy fe eding tube; these were discontinued in 6 of the 9 patients as the defi cits resolved. The majority of the permanent cranial nerve deficits in volved the sixth and seventh cranial nerves. Of the 11 patients, 4 hav e died (progressive disease, n = I; accidental death, n = 2; withdrawa l of life support, n = 1); the remaining 7 patients are alive, with a median follow-up of 37 months (range: 20-73 months). Aggressive surgic al resection for tumors arising in the C-P region is associated with p ostoperative deficits, which resolve over time with appropriate suppor tive care, This approach may increase the number of children in whom G TR is achieved, thereby potentially increasing the cure rate for these patients.