Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review

Abstract

We performed a systematic review to define the long-term health problems and optimal treatment strategy for patients with neuroblastoma with intraspinal extension. Of 685 identified studies, 28 were included in this review. The burden of long-term health problems is high; a median of 50% of patients suffered from neurological motor deficit, 34% from sphincter dysfunction, and 30% from spinal deformity. The currently available literature remains suboptimal as a guide for treatment of NBL with intraspinal extension. More well-designed, prospective studies are needed to determine the optimal treatment strategy.

Multidisciplinary surgical strategy for dumbbell neuroblastoma: A single‐center experience of 32 cases

“…Similar to the median incidence observed in the literature, we reported 48.2% of neurological sequelae, three linked to spinal cord ischemia and six to the involvement of roots by the tumor and/or sacrifice required for resection—two different mechanisms that should be differentiated. Permanent neurogenic bladder was observed in only two cases (6.8%), comparing favorably with the literature with a median incidence of 38% . While the overall incidence of sequelae was 65.5%, a number higher than that previously reported in literature review (59%), our cohort represents a very high risk population with 93.8% of patients with a spinal canal extension of more than one‐third of the spinal canal axis at diagnosis and of whom only 24% showed disappearance of this risk factor after chemotherapy.…”

“…Severe impairment at presentation has been associated with an increased risk of poor functional recovery and long‐term sequelae . Similar to the median incidence observed in the literature, we reported 48.2% of neurological sequelae, three linked to spinal cord ischemia and six to the involvement of roots by the tumor and/or sacrifice required for resection—two different mechanisms that should be differentiated. Permanent neurogenic bladder was observed in only two cases (6.8%), comparing favorably with the literature with a median incidence of 38% .…”

“…In our series, laminoplasty was favored for its supposed preservation of spinal stability resulting in less spine deformities . Three patients (10%) presented with orthopedic sequelae, a low incidence when compared with a median of 30% reported by the systematic review done by Kraal et al . This may be related to the monocentric nature of our series and the continuity in the multidisciplinary management of patients from diagnosis.…”

“…6,8,18 Only two These results confirmed the specificity of NBL arising from the paravertebral sympathetic chain or extending in the spinal canal through the foramina, which are associated with a favorable biology and good outcome in terms of OS and event-free survival. 15 The prognosis of dumbbell NBL is largely linked to functional sequelae resulting from SCC or the involvement of nerve roots and/or of spinal deformities associated with the neurosurgical approach. 9 In our series, laminoplasty was favored for its supposed preservation of spinal stability resulting in less spine deformities.…”

“…Patients with symptomatic spinal cord compression (SCC) received chemotherapy and steroids according to the current running International Society of Paediatric Oncology European Neuroblastoma (SIOPEN) protocols . Neurosurgical spinal cord decompression was performed if symptoms did not resolve within 48 H.…”