Extrinsic spinal cord mass lesions

Tumors that arise outside the substance of the spinal cord can be divided into intradural but extramedullary lesions and extradural and extramedullary lesions. Different groups of tumors appear at different sites and behave quite differently. The presentation, however, can be quite similar and is distinct from that of an intraparenchymal spinal cord mass. The prognosis depends on the histopathology. In cases of cord compression, surgery is indicated, but for many of the other tumors, radiation therapy and chemotherapy are appropriate, particularly if the lesion is a metastatic process. Both treatment approaches have obvious inherent problems in children. Extensive laminectomies can induce secondary spinal deformity in children, particularly kyphosis, and adverse effects of both chemotherapy and radiation therapy can cause significant stunting or asymmetry of growth or induce endocrine or other problems. It is critical for the pediatrician to recognize the patient who may have an intraspinal mass, to obtain an MRI scan quickly in those suspected of having an intraspinal mass, and to entertain the diagnosis of a psychiatric illness or social problem only after performing a full diagnostic evaluation. With this approach, many children who previously presented very late with diffusely spread disease may have their condition better controlled and possibly cured.