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