Complicatons of Therapies for Infratentorial Ependymomas in Children

Surgical

Hydrocephalus after tumor resection

• Unusual to require treatment: Permanent CSF diversion after complete or near-complete tumor resection is usually not required.
• Risk factors include young age and large tumors: The need for postoperative shunt placement is more likely in younger patients and those with large tumors or long-standing ventriculomegaly (22).
• Elevated ICP and treatment of CSF leak: Elevated ICP in association with large ventricles can be a factor leading to treatment, as can progressive ventriculomegaly on postoperative imaging studies. A pseudomeningocele that is enlarging and/or a CSF leak are events that will lead to consideration for treatment.

Cranial nerve injury

• Direct surgical injury: Lower cranial nerve injury, mostly seen with laterally located tumors, is usually temporary, but sometimes tracheostomy or gastrostomy is needed.