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Primary Spinal Cord Tumors in Children: A Multi-institutional Retrospective Study from Pakistan
Farrah Bashir1, Salaar Ahmed2,3, Syed M Hussnain Sherazi2
1Department of Oncology, Aga Khan University, National Stadium Road, Karachi, Pakistan. farrah.bashir@aku.edu.
Insights
Pediatric primary spinal cord tumors (PSCTs) in Pakistan show delayed diagnosis and varied histopathology. High-grade tumors have poor outcomes, emphasizing the need for improved care in low- and middle-income countries (LMICs).
Area of Science:
- Pediatric neuro-oncology
- Clinical neurosurgery
- Oncology
Background:
- Primary spinal cord tumors (PSCTs) are rare in children, with limited data from low- and middle-income countries (LMICs).
- Variability in presentation, pathology, and treatment in resource-constrained settings complicates diagnosis and management.
- This study details the epidemiology, clinical features, histopathology, and outcomes of pediatric PSCTs in Pakistan.
Purpose of the Study:
- To describe the characteristics and outcomes of pediatric PSCTs managed at tertiary care centers in Pakistan.
- To provide a comprehensive dataset on pediatric PSCTs from a LMIC setting.
- To identify challenges and areas for improvement in managing pediatric PSCTs in resource-limited environments.
Main Methods:
- Retrospective, multicenter review of pediatric PSCT cases from January 2010 to December 2024.
- Data extraction included demographics, symptoms, MRI findings, surgical details, and histopathology using REDCap.
- Statistical analysis performed using R version 4.2.0.
Main Results:
- 47 pediatric patients with PSCTs were analyzed; median age was 14 years, with a mean symptom duration of 7.5 months.
- Intramedullary tumors were predominant (63.6%), with ependymomas (36.2%) and gliomas (25.5%) being the most common histologies.
- Gross total resection (GTR) was achieved in 53.8% of treated patients; all high-grade glioma patients died during treatment.
Conclusions:
- This study presents the largest pediatric PSCT dataset from Pakistan, revealing delayed presentations and significant histopathological diversity.
- Outcomes for high-grade tumors remain poor, highlighting the critical need for earlier diagnosis and standardized care.
- Strengthening neurosurgical capacity and multidisciplinary approaches is essential for improving outcomes in LMICs.
Background:
Primary spinal cord tumors (PSCTs) are rare in children, accounting for 2-4% of pediatric central nervous system tumors, with limited data available from low- and middle-income countries (LMICs). Variability in clinical presentation, histopathological patterns, and treatment practices in resource-constrained settings further challenges early diagnosis and optimal management. This study describes the epidemiology, clinical features, histopathology, and treatment outcomes of pediatric PSCTs managed at three major tertiary care centers in Pakistan.
Methods:
We conducted a retrospective, multicenter review of all children and adolescents diagnosed with PSCTs between January 2010 and December 2024 at three tertiary care cancer hospitals. Demographics, presenting symptoms, MRI features, surgical details, histopathology, and outcomes were extracted using REDCap and analyzed using R version 4.2.0.
Results:
Among 47 pediatric patients, the median age at diagnosis was 14 years (IQR 9-16), with a mean symptom duration of 7.5 ± 9.1 months. Most tumors were intradural (97.8%), predominantly intramedullary (63.6%). Limb weakness (80.9%) and back pain (66.0%) were the most common symptoms of presentation. Ependymomas were the most frequent histopathology (36.2%), followed by gliomas (25.5%), including four high-grade gliomas. Of 39 patients who underwent treatment, GTR was achieved in 53.8%, while STR was performed in 30.8%. Surgical complications occurred in six patients, and treatment-related complications occurred in three patients. All patients with high-grade gliomas died during treatment.
Conclusion:
This multicenter study provides the most comprehensive pediatric PSCT dataset from Pakistan, highlighting delayed presentations, predominance of intramedullary tumors, and significant histopathological variability. Outcomes remain limited for high-grade tumors, underscoring the need for earlier diagnosis, standardized multidisciplinary care, and strengthened neurosurgical capacity in LMICs.
