室管膜瘤通常被归类为世界卫生组织 2 级，间变性变异被归类为 3 级。不完全切除或间变性特征可能会导致不良结果。立体定向放射外科（SRS）为复发性室管膜瘤提供了一种微创方法。我们的研究调查了 SRS 对儿童和成人 2 级和 3 级室管膜瘤的疗效和安全性。我们对 1998 年至 2023 年间接受射波刀 SRS 治疗后患有 75 例室管膜瘤的 34 名患者进行了回顾性分析。其中 14 例是儿科患者（3-18 岁）， 20 名是成年（19-75 岁）患者。中位年龄为 21 岁，中位肿瘤体积为 0.64 cc。中位单次等效剂量为 16.6 Gy，SRS 给药剂量为中位等剂量线的 77%。中位随访 42.7 个月（范围：3.8-438.3）后，22.7% 的室管膜瘤出现进展。 5年局部肿瘤控制率为78.1%，儿童和成人为59.6%至90.2%，2级肿瘤为85.9%，3级肿瘤为58.5%。 5年总生存率为73.6%，成人（94.7%）显着高于儿童（41%），2级患者的5年总体生存率为100%，但3级患者的5年总体生存率下降至35.9%。 5年无进展生存率为68.5%，其中成人和儿童分别为78.3%和49.2%，2级患者的5年无进展生存率为88.8%，而3级患者的5年无进展生存率为32.6%。 85.3% 的患者症状得到改善。 21.4% 的儿科患者出现放射不良反应。我们的研究支持 SRS 作为 2 级和 3 级室管膜瘤儿科和成人患者的可行治疗方法。尽管儿科和 3 级病例的局部肿瘤控制较低，但整合 SRS 有望改善预后。强调仔细的患者选择、个性化治疗计划和长期随访对于最佳神经外科手术结果至关重要。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 代表神经外科医生大会出版。

Ependymoma is commonly classified as World Health Organization grade 2 with the anaplastic variant categorized as grade 3. Incomplete resection or anaplastic features can result in unfavorable outcomes. Stereotactic radiosurgery (SRS) provides a minimally invasive approach for recurrent ependymomas. Our study investigates the efficacy and safety of SRS for grade 2 and 3 ependymomas in pediatric and adult populations.We conducted a retrospective analysis on 34 patients with 75 ependymomas after CyberKnife SRS between 1998 and 2023. Fourteen were pediatric (3-18 years), and 20 were adult (19-75 years) patients. The median age was 21 years, and the median tumor volume was 0.64 cc. The median single-fraction equivalent dose was 16.6 Gy, with SRS administered at 77% of the median isodose line.After a median follow-up of 42.7 months (range: 3.8-438.3), 22.7% of ependymomas progressed. The 5-year local tumor control rate was 78.1%, varying between 59.6% and 90.2% for children and adults, with grade 2 at 85.9% compared with 58.5% for grade 3 tumors. The 5-year overall survival rate was 73.6%, notably higher in adults (94.7%) than in children (41%), and 100% for grade 2 but decreased to 35.9% for grade 3 patients. The 5-year progression-free survival rate was 68.5%, with 78.3% and 49.2% for adults and children, respectively, and a favorable 88.8% for grade 2, contrasting with 32.6% for grade 3 patients. Symptom improvement was observed in 85.3% of patients. Adverse radiation effects occurred in 21.4% of pediatric patients.Our study supports SRS as a viable modality for pediatric and adult patients with grade 2 and 3 ependymomas. Despite lower local tumor control in pediatric and grade 3 cases, integrating SRS holds promise for improved outcomes. Emphasizing careful patient selection, personalized treatment planning, and long-term follow-up is crucial for optimal neurosurgical outcomes.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.