Pediatric spinal ependymomas: Long‐term surgical outcomes in a cohort of 61 cases

ABSTRACT Importance Spinal ependymomas are rare in the pediatric population, with limited evidence of long‐term outcomes and predictors of recurrence. Objective To analyze clinic‐radiological features, therapeutic methods, and long‐term outcomes in a pediatric cohort. Methods We retrospectively reviewed patients ≤18 years who underwent surgical resection for spinal ependymomas between January 2012 and July 2024. Progression‐free survival (PFS) was estimated using Kaplan‐Meier analysis, and predictors of recurrence were analyzed using the Cox proportional hazards method. Results Among 61 children (age 13.7 ± 3.7 years), spinal ependymoma (EPN) (WHO grade 2) was the most common subtype ( n = 36, 59.0%), followed by myxopapillary ependymoma (MPE) ( n = 13, 21.3%), EPN (WHO grade 3) ( n = 11, 18.1%) and subependymoma (SE) ( n = 1, 1.6%). Gross‐total resection (GTR) was achieved in 38 patients (62.3%). Over a follow‐up of 42.8 ± 34.9 months, 19 patients (31.1%) experienced tumor recurrence. Functional improvement was observed in 38 children (62.3%). The 5‐ and 10‐year progression‐free survival (PFS) rates were 73.4% and 59.6%, respectively. In grade 2 EPN, subtotal resection (STR) followed by radiotherapy yielded significantly better 5‐ and 10‐year PFS than STR alone (100% vs. 42.9%; 66.7% vs. 21.4%, respectively). Multivariable analysis identified extent of resection ( P = 0.015), MPE subtype ( P = 0.014), and Ki‐67 ≥8% ( P = 0.001) as independent predictors of recurrence. Interpretation GTR remains the best treatment modality for pediatric patients with spinal ependymomas and has a favorable prognosis. Tumor recurrence is common and is related to the Ki‐67 index, histological subtype, and the extent of resection.