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Intramedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study
G Innocenzi1, A Raco, G Cantore
1Division of Pediatric Neurosurgery, La Sapienza University, Rome, Italy.
Insights
Pediatric spinal cord tumors, astrocytomas and ependymomas, show different prognoses and surgical strategies. Patient
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Spinal Cord Tumors
Background:
- Intramedullary astrocytomas and ependymomas are primary spinal cord tumors in children.
- Surgical management and prognosis vary between these pediatric tumor types.
Purpose of the Study:
- To compare the outcomes and surgical strategies for pediatric intramedullary astrocytomas and ependymomas.
- To evaluate factors influencing prognosis in these pediatric spinal cord tumors.
Main Methods:
- Retrospective analysis of 45 pediatric patients with intramedullary astrocytoma or ependymoma.
- Surgical data, including extent of resection, and patient neurological status were reviewed.
- Radiotherapy use and its impact were assessed in a subset of patients.
Main Results:
- Gross total removal was achieved in 70% of ependymomas versus 33% of astrocytomas.
- Extent of resection did not significantly impact prognosis for astrocytomas.
- Initial neurological condition was a critical prognostic factor, with patients in good condition faring better post-operatively.
Conclusions:
- Intramedullary astrocytomas and ependymomas in children necessitate distinct surgical approaches.
- Preoperative neurological status is a key determinant of long-term outcomes in pediatric spinal cord tumor surgery.
- Radiotherapy's role remains uncertain due to limited use, reserved for highly malignant cases.
Abstract:
A series of 45 pediatric patients underwent surgery for intramedullary astrocytoma or ependymoma at the Cook County Hospital or the Children's Memorial Hospital of Chicago (Northwestern University) and the Neurosurgical Department of Rome "La Sapienza" University. Results showed that intramedullary astrocytomas and ependymomas in children differ from one another in terms of prognosis, and particularly as regards surgical strategy as an element of therapeutic management. Gross total removal of 70% of the ependymomas was achieved, in comparison to 33% of the astrocytomas. In astrocytomas the extent of resection did not significantly influence prognosis. Neurological condition on admission, regardless of oncotype, was found to be extremely influential: patients operated in good condition tended to remain neurologically stable or improve in the long term, while those operated on while in poor condition did not show any improvement at all. No definitive conclusions were possible regarding the value of radiotherapy, because it was only performed in 6 of the 45 cases. The authors limited its use to highly malignant lesions in view of the well-known sensitivity of the spinal cord to radiation, especially in children.
