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Intramedullary spinal cord tumors in children
George I Jallo1, Diana Freed, Fred Epstein
1Division of Pediatric Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Harvey 811, Baltimore, MD 21287, USA. gjallo1@jhmi.edu
Introduction:
Pediatric intramedullary spinal cord tumors are rare and make up only a small percentage of all central nervous system neoplasms.
Discussion:
These neoplasms are predominantly benign histologically, regardless of size, with a large percentage being astrocytomas or gangliogliomas. Ependymomas, which are common in adults, are relatively uncommon in children. Contemporary management of these tumors has generated much controversy. These neoplasms occur primarily in the cervical region, with pain or a motor deficit as the chief complaint. Surgery on these neoplasms can safely be performed using modern surgical adjuncts such as the ultrasonic aspirator, contact laser and neurophysiological monitoring. A radical resection of these tumors results in a good long-term outcome, since the majority are histologically benign. Adjuvant radiation therapy should only be administered for high-grade or malignant tumors.
Conclusion:
The majority of spinal cord tumors are benign; however, malignant tumors have a dismal outcome and surgery in these children should be limited to a conservative debulking. An attempt should be made for radical surgery in hope of avoiding radiation and chemotherapy for the benign tumors. Spinal deformity is a concern in these patients since 35% of children may require a stabilization procedure.