Three-Level Anterior Cervical Corpectomy for Resection of Disseminated Posterior Fossa Ependymoma: Case Report and Review of the Literature

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Background: Low-grade posterior fossa ependymomas are neoplasms that rarely disseminate at the initial presentation or recurrence. Methods: We describe a case of low-grade posterior fossa ependymoma initially treated with resection and radiation 20 years prior. At the time of presentation, multiple intracranial and spinal lesions were identified, most notably a non-enhancing ventral intradural lesion at C6-7. Results: The 56-year-old presented with progressive left upper and lower extremity weakness. He underwent resection of the ventral intradural lesion at C6-7. The surgery involved a C5-7 corpectomy for resection and a C2-T3 posterior spinal fusion for stabilization. His weakness resolved postoperatively. We then present a systematic review of the literature on the dissemination of low-grade posterior fossa ependymoma. Fifteen studies were identified, involving 23 patients. Conclusion: Late dissemination of low-grade posterior fossa ependymoma could arise decades after the initial surgery despite gross-total resection and adjuvant radiotherapy. Malignant transformation and multicentric tumor development may also occur after treatment of the primary ependymoma. A varied extent of resection and adjuvant therapies have been involved in treating disseminated conventional posterior fossa ependymoma, with surgical decisions largely dependent on a multifactorial basis.

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