Gross total resection drives survival in pediatric ependymoma: A single-center analysis of clinical and anatomical predictors

One of the most difficult conditions in pediatric neurosurgery is pediatric intracranial ependymomas, which are aggressive tumors that are typically found in the posterior fossa. The impact of tumor localization, histological grade, and adjuvant therapy is still debatable, despite the fact that extent of resection is generally considered to be the most significant prognostic factor. 27 children who had surgery for intracranial ependymoma between January 2015 and January 2025 were the subject of a retrospective, single-center investigation. Tumor location, presenting symptoms, degree of resection, adjuvant therapy, surgical complications, spread of cerebrospinal fluid (CSF), and overall survival (OS) outcomes were all assessed. The Kaplan–Meier technique and Cox proportional hazards regression were used for survival analysis. Twenty-nine pediatric patients were initially identified; after exclusion of two patients due to insufficient follow-up, 27 patients were included in survival analyses. Gross total resection (GTR) was significantly associated with improved overall survival compared with subtotal resection (p < 0.001). Kaplan–Meier analysis demonstrated 1-, 3-, and 5-year overall survival rates of 85.2%, 54.6%, and 40.4%, respectively. No other variables, including histopathological grade, adjuvant therapy, or postoperative complications, emerged as independent predictors of survival, likely reflecting limited statistical power. In pediatric intracranial ependymomas, the degree of resection continues to be the most significant predictor of survival. Surgical feasibility is largely determined by radiological characteristics, especially brainstem adhesion and expansion into crucial cisternal regions. To improve customized treatment plans and improve prognostication, future multicenter research utilizing molecular subgrouping is crucial.