Background: Ependymomas of the fourth ventricle are a significant clinical challenge in pediatric neurosurgery, representing a substantial portion of central nervous system tumors in children. Prognosis largely depends on the tumor's anaplasia grade, extent of surgical resection, and subsequent treatment strategies.

Methods: A retrospective analysis was conducted on 49 pediatric patients (aged 2–15 years) with fourth-ventricle ependymomas treated between 2022 and 2024. The degree of tumor resection was assessed using the "Tumor Volume Calculation" program, and postoperative outcomes, survival rates, and “quality of life” (QoL) were evaluated using established scales.

Results: Total tumor resection was achieved in 70.8% of patients, with postoperative mortality rates of 3.1% and 5.0% for total and subtotal resections, respectively. Five-year survival rates were 98.7% for Grade I–II tumors and 64.5% for Grade III tumors treated with adjuvant therapies. QoL assessments revealed that 41.0% of patients had good QoL, 54.2% satisfactory, and 4.8% poor. Extent of resection removal significantly impacted long-term QoL, with total resections yielding superior outcomes (53.6% improvement).

Conclusion: The effectiveness of treatment for pediatric fourth-ventricle ependymomas depends on the extent of tumor resection and subsequent therapy. Total resection, where feasible, significantly improves survival rates and long-term QoL.

Ependymomas, fourth ventricle, pediatric neurosurgery, tumor resection, quality of life

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