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Decoding pediatric spinal tumors: a single-center retrospective case series on etiology, presentation, therapeutic
Pavlina Lenga1,2, Daniel Kühlwein3, Martin Grutza3
1Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. pavlina.lenga@med.uni-heidelberg.de.
Insights
Pediatric spinal tumors (ST) are rare but serious, often causing paralysis. Early, individualized treatment, including surgery, significantly improves mobility and outcomes for affected children.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Oncology
Background:
- Spinal tumors (ST) in children present a significant challenge due to their rarity and potential for severe neurological deficits.
- Limited data exists on the incidence, etiology, and outcomes of pediatric spinal tumors.
Purpose of the Study:
- To investigate the etiology, clinical manifestations, treatment strategies, and outcomes of pediatric spinal tumors.
- To highlight the importance of early, individualized therapeutic approaches for this rare patient group.
Main Methods:
- A retrospective review of 14 pediatric patients under 18 years old diagnosed with spinal tumors between 2005 and 2020.
- Analysis of clinical presentations, diagnostic evaluations, molecular diagnostics, and treatment interventions.
Main Results:
- The study included 14 pediatric patients with diverse spinal tumor types, with a mean age of 19.6 months.
- Severe axial pain and acute neurological deterioration were common, affecting 13 and 7 patients, respectively.
- Surgical decompression and tumor resection were performed in 13 patients, leading to ambulation recovery in 6 out of 7 previously non-ambulatory patients. Diagnoses included Ewing sarcoma, teratoma, astrocytoma, neuroblastoma, and others. Three patients died within two years.
Conclusions:
- Pediatric intraspinal tumors require prompt, individualized treatment strategies to optimize outcomes.
- Establishing a patient registry is crucial for advancing the understanding and management of these rare pediatric neoplasms.
- Multidisciplinary care is essential for addressing the complex needs of children with spinal tumors.
Introduction:
Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST.
Methods:
We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients.
Results:
The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy.
Conclusion:
Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
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