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Paraplegia after chest wall resection for primitive neuroectodermal tumor.

Jon Ryckman¹, Jean-Martin Laberge, Pramod S Puligandla

¹Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada.

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|April 8, 2009

Summary

A pediatric patient developed paraplegia following chest wall tumor resection due to spinal cord compression from a hemorrhage. This rare complication highlights the risk of bleeding from enlarged Batson

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Area of Science:

Pediatric Surgery
Neuro-oncology
Spinal Cord Injury

Background:

Spinal cord complications are infrequent in elective pediatric surgery.
Primitive neuroectodermal tumors (PNETs) can occur in the chest wall.
Surgical resection of chest wall tumors near the spine poses unique risks.

Observation:

A 10-year-old girl with PNET experienced paraplegia post-resection.
Hemorrhage during rib disarticulation led to spinal cord compression.
Postoperative MRI revealed T4 spinal cord compression from a hematoma.

Findings:

Surgical intervention included decompression and laminectomy.
Hematoma contained blood clot and hemostatic material (Surgicel).
Encountered giant epidural veins with significant bleeding during decompression.

Implications:

Chest wall tumors near the spinal canal may involve enlarged Batson's plexus, increasing hemorrhage risk.
Recommend prompt imaging or prophylactic laminectomy for suspected spinal hemorrhage.
Emphasize regular neurovital monitoring in pediatric patients undergoing spinal proximity surgery.