Pediatric Spinal Cord Tumors and Masses

Abstract

Background/Objective: Spinal cord tumors are a relatively rare diagnosis, accounting for 1% to 10% of all pediatric central nervous system tumors. Understanding the etiology and clinical outcomes of these tumors is therefore very important. This study presents detailed information regarding clinical presentation, histological findings, outcomes, functional assessment, and management of a series of patients with this diagnosis.Method: Retrospective, descriptive study.Subjects: Thirty-five children with a final diagnosis of spinal cord tumor or mass, excluding dysraphism.Results: Neurodevelopmental tumors (dermoid tumors, epidermoid tumors, and teratomas) were the most common tumor type (31%), followed by astrocytomas (29%) and neuroblastomas (14%). Other types included schwannomas, meningiomas, giant cell tumors, extradural cystic masses, leukemic-related masses, and masses related to neurofibromatosis. Mean age at diagnosis was 6.6 years (SD ¼ 5.5 y) and did not vary significantly by tumor type except for children with neuroblastoma (mean ¼ 0.4 y, SD ¼ 0.5 y). More boys (57%) were identified in the series than girls (43%); however, there was no association between tumor type and sex. Presenting complaints of pain were noted in 57% and were localized to the back, neck, or extremities. Extremity weakness was reported as an initial presenting symptom in 46%. Three children had scoliosis as a presenting issue and 14 had gait abnormalities. Regardless of treatment modality, mobility was retained in 83% of children with or without gait aids. Neurogenic bowel and/or bladder were present in 23% of the population.Conclusions: This study corroborates other studies indicating that intramedullary tumors are the predominant form of pediatric spinal cord tumor. This population, however, presented with an unusually large number of developmental tumors, contrary to several published studies. The disparity may be the result of this institution acting as a regional referral center, thus increasing the number of this type of patient. The population is too small to make any other conjecture. The predominance of astrocytomas and neuroblastomas among those patients with poor outcomes and the prevalence of developmental tumors suggest the need for broader investigation. Although, in general, spinal cord tumors are relatively rare, this preliminary study supports the need to further evaluate associations between tumor type, presenting symptoms, treatment, and functional outcome in children with spinal cord tumors.J Spinal Cord Med. 2007;30:S15-S20

Imaging of Back Pain in Children

“…Although uncommon, high-grade neoplasms (WHO grades 3 and 4) may also occur. 114 Astrocytomas are slow-growing tumors that may present clinically with back pain, paresthesias, and spasticity. Subarachnoid dissemination may occur.…”

Post-laminectomy rotokyphoscoliosis causing paraplegia in long term: Case report

“…This tumor type represents 29% of pediatric spinal cord tumors. 7 She reported no weakness, sensory deficit, or fecal or urinary incontinence after the surgery. Kyphosis had begun to develop 2 years after the surgery.…”

Value of Laminoplasty in Children with Spinal Tumors

“…A recent study by Spacca et al, 21 reported an improvement of 100 (74.6%) out of 134 children operated for spinal tumors, 10 patients (7.4%) were unchanged and 8 patients (5.9%) had neurologically worsened at the last follow-up (mean 28 months, range 3 months to 13 years). One patient with intramedullary tumor in our study (14.3% of the patients with intramedullary tumors) developed a transient neurological deterioration post-operatively he recovered completely to the preoperative status within two weeks.…”

“…Treatment must consider the natural history of the tumor, but when it comes to defining the treatment plan, it is important to evaluate the requirements of a growing spine. 21 One of the late serious complications after laminectomy in spinal tumor resection in children is spinal instability and deformity mainly kyhpotic deformity that may require subsequent fusion affecting the functional outcome. 5,6,11,18,19 There are some predictors that increase the incidence of spinal deformity after laminectomy in children including multilevel, junctional zone laminectomy 11 and adjuvant radiotherapy.…”

“…They reported that at a median of 3.5 years after surgery, only 1 patient (5%) in the laminoplasty cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (P=0.027) and laminoplasty was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, P= 0.05). Spacca et al, 21 reported a low risk (3.7%) of secondary spinal instability (five out of 134 patients) that required a surgical treatment after laminoplasty performed during resection of spinal tumors in children. However, Ratliff and Cooper in meta-analysis conducted in 2003 found that there was no benefit of laminoplasty over laminectomy at the cervical level in adult patients regarding the spinal alignment, incidence of kyphotic deformity and neurological outcome.…”