Management of Pediatric Spinal Tumors

Background: spinal tumors constitute about 8 % of central nervous system tumors. They are not uncommon in pediatric population. Objectives: The author reviews his experience in surgical aspects and techniques of management of this subtype of pediatric tumors. Patients and Methods: Medical records of twenty five pediatric patients with spinal tumors admitted to Children's Cancer Hospital-Egypt (CCHE-57357) during the period from July 2007 to June2012 were retrospectively reviewed as regard details of clinical presentation, surgical aspects, tumor pathology, surgical outcome and complications. Mean age at presentation was 3.8 years (range 1.5-16). Male to female ratio was 1.3:1. Results: Commonest initial presentations were motor deficits, sphincteric disturbance, sensory deficits and pain in twenty two (88%), ten (40%), fifteen (60%), twelve (48%) patients, respectively. Commonest tumors were ependymomas and astrocytomas (40%). Rare entities included chondrosarcoma and Bilharzioma. Extent of surgical excision was: total excision was achieved in 36%, near-total/subtotal excision in 48% and biopsy in 16%, respectively. Postoperatively, neurological deficits improved in twelve cases, stabilized in eleven cases and aggravated in two cases, respectively). Intraoperative ultrasonography was utilized in nineteen cases. Intraoperative neuro-physiological monitoring was utilized in twenty cases. Anal EMG was the only positive indicative parameter for intraoperative guidance in five cases. Conclusion: Management of pediatric spinal tumors is challenging. Our management strategy relies mainly on optimizing safe and maximal tumor excision in cases when there are clear cleavage planes and avoiding total excision in infiltrating tumors. Frozen section pathology is mandatory to decide further surgical attitude. Advanced surgical adjuncts are mandatory for safe and effective surgery of spinal tumors especially intraoperative neurophysiological monitoring and ultrasonography. Anal EMG is of special importance and should not be neglected. Tumor resection should always be controlled by intraoperative neuro-physiological monitoring.