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Updated: Mar 30, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Pediatric intramedullary spinal cord lesions: Pathological spectrum and outcome of surgery
Rajni Kant Sahu1, Kuntal Kanti Das1, Kamlesh Singh Bhaisora1
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Pediatric intramedullary spinal cord lesions are rare and distinct from adult cases. Astrocytomas and ependymomas are most common, with outcomes depending on preoperative status and tumor type.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Oncology
- Pediatric Oncology
Background:
- Pediatric intramedullary spinal cord lesions are uncommon and differ significantly from adult presentations.
- Understanding their incidence, characteristics, and treatment outcomes is crucial for effective pediatric care.
Purpose of the Study:
- To investigate the incidence and types of pediatric intramedullary mass lesions.
- To analyze treatment outcomes and identify factors influencing them in children.
Main Methods:
- Retrospective review of 31 pediatric patients (1-18 years) with pathologically confirmed intramedullary spinal cord lesions.
- Data collected included clinical, radiological, histopathological, and operative details.
- Functional status was assessed using the modified McCormick grading system.
Main Results:
- Gross total excision achieved in 61.3% of patients; subtotal in 29%.
- Complications included wound issues and transient neurological deficits. Recurrence observed in 6 patients, particularly with developmental tumors and incompletely excised ependymomas.
- Children generally presented with good preoperative functional grades, maintained post-surgery.
Conclusions:
- Intramedullary spinal cord tumors represent 17.4% of cases in children, with astrocytomas and ependymomas being most frequent.
- Developmental tumors were predominant in the first decade of life.
- Surgical outcomes are primarily influenced by preoperative neurological status and lesion histopathology.
Background:
Pediatric intramedullary spinal cord lesions are not only rare but also different from adults in a number of aspects. We aimed to study the incidence and the frequencies of various pediatric intramedullary mass lesions, their outcome to treatment and the factors determining their outcome of treatment.
Materials And Methods:
Thirty-one consecutive children (aged 1-18 years, mean 11.1 years, male: female = 1.8:1) with pathologically proven intramedullary spinal cord lesions treated at our center were studied. Clinico-radiological, histopathological, operative, and outcome data were reviewed retrospectively. The functional status was assessed using the modified McCormick grading system.
Results:
Gross total tumor excision was performed in 19 patients (61.3%), subtotal in 9 patients (29%), partial excision was performed in 2 (6.5%) patient, and only biopsy was performed in 1 patient (6.5%). There was one peroperative death, 2 patients died at follow-up. Complications included wound related complications (n = 4), transient deterioration in the motor power, and respiratory complication requiring a tracheostomy. Six patients showed recurrence at a mean follow-up of 16.4 months. Developmental tumors, high-grade ependymomas, and incompletely excised grade 2 ependymomas showed a tendency to recur.
Conclusions:
Children constituted nearly 1/5(th) (17.4%) of intramedullary spinal cord tumors. Astrocytomas and ependymomas taken together constituted the most common intramedullary spinal lesions in children; however, developmental tumors predominated in the first decade. Children usually presented in good functional grades preoperatively and maintained good grades after surgery. Functional outcome was dependent on the preoperative neurological status and histopathology of the lesions.
