Marx S, et al. – Authors here evaluate the outcome of posterior fossa ependymoma gross total resection in adult patients using a four–hand suction–irrigation technique at the floor of the fourth ventricle. Findings suggest the possibility of long–term progression free survival in adult patients suffering from posterior fossa ependymoma by gross total resection without adjuvant radio– or chemotherapy. By careful bimanual microsurgical dissection using the four–hand suction–irrigation technique and avoidance of bipolar coagulation on the floor of the fourth ventricle, the risk for permanent neurological deficits is low.