Abstract
Intramedullary spinal cord tumors (IMSCTs) of the pediatric population are rare and comprise thirty-five percent of intraspinal neoplasms. Low-grade astrocytomas predominate; ependymomas increase in frequency with ascending age and become the most frequent IMSCT in adults. Gangliogliomas are very rare in adults but comprise nearly thirty percent of tumors in children under three years of age. The cervical spine is the region of the spine most affected. Pain is the most common presenting symptom with weakness, gait deterioration, torticollis also frequently reported. Hydrocephalus occurs with greater frequency than in adult patients and often requires a shunt. Motor and sensory evoked potential monitoring is routinely utilized. Osteoplastic laminotomy is performed to forestall the development of progressive spinal deformity. Gross total resection is feasible in most ependymomas and results in surgical cure. Astrocytomas are infiltrating neoplasms and gross total resection is occasionally possible only in the pediatric population. However, the role of radical resection of low-grade fibrillary astrocytomas of the spinal cord in children has not been definitively demonstrated in the literature. Outcome for low-grade astrocytomas is better in children than adults, but not as favorable as that for ependymomas. Malignant tumors have dismal outcomes and surgery in these patients serves only to provide a diagnosis.
Similar content being viewed by others
References
Constantini S, Epstein FJ: Intraspinal tumors in infants and children. In: Youmans J (ed), Neurological Surgery. Vol. 4, 4th edn. WB Saunders, Philadelphia, 1996, pp 3123-3133
Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Epstein FJ: Intramedullary spinal cord tumors in children under the age of 3 years (see comments). J Neurosurg 85: 1036-1043, 1996
Fischer G, Brotchi J; Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 72-81
Neumann HP, Eggert HR, Weigel K, Friedburg H, Wiestler OD, Schollmeyer P: Hemangioblastomas of the central nervous system. A 10-year study with special reference to von Hippel-Lindau syndrome. J Neurosurg 70: 24-30, 1989
DeSousa AL, Kalsbeck JE, Mealey J Jr, Campbell RL, Hockey A: Intraspinal tumors in children. A review of 81 cases. J Neurosurg 51: 437-445, 1979
Cohen AR, Wisoff JH, Allen JC, Epstein F: Malignant astrocytomas of the spinal cord. J Neurosurg 70: 50-54, 1989
Allen JC, Yates AJ, Boyett JM, Cherlow JM, Turski PA, Epstein FJ, Findlay JL: Children's Cancer Group: treatment of high grade spinal cord astrocytoma of childhood with ‘8-in-1’ chemotherapy and radiotherapy; a pilot study of CCG-945. J Neurosurg 88: 215-220, 1998
Reimer R, Onofrio BM; Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63: 669-675, 1985
Epstein F, Epstein N; Surgical management of holocord intramedullary spinal cord astrocytomas in children. J Neurosurg 54: 829-832, 1981
Weiner HL, Freed D, Woo HH, Rezai AR, Kim R, Epstein FJ: Intra-axial tumors of the cervicomedullary junction: surgical results and long-term outcome. Pediatr Neurosurg 27: 12-18, 1996
Osborn AG: Diagnostic Neuroradiology. Mosby, St. Louis, 1994, pp 906-914
Sandler HM, Papadopoulos SM, Thornton AF, Jr, Ross DA: Spinal cord astrocytomas: results of therapy (see comments). Neurosurgery 30: 490-493, 1992
Cooper PR; Management of intramedullary spinal cord tumors. In: Tindall GT, Cooper PR, Barrow DL (eds) The Practice of Neurosurgery. Vol 2. Williams and Wilkins, Baltimore, 1996, pp 1335-1346
Rifkinson-Mann S, Wisoff JH, Epstein F; The association of hydrocephalus with intramedullary spinal cord tumors: a series of 25 patients. Neurosurgery 27: 749-754, 1990
Fischer G, Brotchi J, Chignier A, Liard G, Zomosa G, Menei P, Hallacq P: Clinical material. In: Fischer G, Brotchi J (eds) Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 10-20
Kearse LA Jr, Lopez-Bresnahan M, McPeck K, Tambe V: Loss of somatosensory evoked potentials during intramedullary spinal cord surgery predicts postoperative neurologic deficits in motor function (corrected) (published erratum appears in J Clin Anesth 1993 Nov-Dec; 5(6): 529). J Clin Anesth 5: 392-398, 1993
Morota N, Deletis V, Constantini S, Kofler M, Cohen H, Epstein FJ: The role of motor evoked potentials during surgery for intramedullary spinal cord tumors. Neurosurgery 41: 1327-1336, 1997
Kothbauer K, Deletis V, Epstein FJ: Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 26: 247-254, 1997
Nadkarni TD, Rekate HL: Pediatric intramedullary spinal cord tumors. Critical review of the literature. Childs Nerv Syst 15: 17-28, 1999
Yasuoka S, Peterson HA, MacCarty CS: Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 57: 441-445, 1982
Goh KY, Velasquez L, Epstein FJ: Pediatric intramedullary spinal cord tumors: is surgery alone enough? Pediatr Neurosurg 27: 34-39, 1997
Abbott R, Feldstein N, Wisoff JH, Epstein FJ: Osteoplastic laminotomy in children. Pediatr Neurosurg 18: 153-156, 1992
Papagelopouluos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM: Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine 22: 442-451, 1997
Cristante LHH; Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35: 69-76, 1994
Innocenzi G, Salvati M, Cervoni L, Delfini R, Cantore G: Prognostic factors in intramedullary astrocytoma. Clin Neurol Neurosurg 99: 1-5, 1997
Samii M, Klekamp J: Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 35: 865-873; discussion 873, 1994
McCormick PC, Torres R, Post KD, Stein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72: 523-532, 1990
Lang FF, Epstein FJ, Ransohoff J, Allen JC, Wisoff J, Abbott IR, Miller DC: Central nervous system gangliogliomas. Part 2: Clinical outcome. J Neurosurg 79: 867-873, 1993
Epstein FJ, Farmer JP, Freed D: Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77: 355-359, 1992
Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC: Management of intramedullary spinal cord tumors. Radiology 135: 473-479, 1980
Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM: Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 83: 590-595, 1995
O'Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML: Spinal cord tumors in children: long term results of combined surgical and radiation treatment. J Neurosurg 81: 507-512, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Houten, J.K., Weiner, H.L. Pediatric Intramedullary Spinal Cord Tumors: Special Considerations. J Neurooncol 47, 225–230 (2000). https://doi.org/10.1023/A:1006418506213
Issue Date:
DOI: https://doi.org/10.1023/A:1006418506213