Cervical subluxation after surgery and irradiation of childhood ependymoma

Aggressive resection followed by postoperative radiation therapy directed at the tumor bed characterizes the treatment of childhood infratentorial ependymoma. Tumor resection often requires access to the upper portion of the cervical spinal canal, which places the patient at risk of complications, including destabilization. Two cases of cervical subluxation after surgery and irradiation for infratentorial ependymoma are presented and discussed to identify factors that may be responsible for this uncommon treatment complication. Cervical laminotomies, multiple surgeries, postoperative infection and the addition of radiation therapy may be contributory. Because second resection will be an important component of the next generation of cooperative group studies for infratentorial tumors, the incidence and severity of this treatment-related complication should be documented and efforts should be made to image the upper portion of the cervical spine during routine follow-up.