Pediatric intramedullary spinal cord tumors: special considerations

Intramedullary spinal cord tumors (IMSCTs) of the pediatric population are rare and comprise thirty-five percent of intraspinal neoplasms. Low-grade a strocytomas predominate; ependymomas increase in frequency with ascending a ge and become the most frequent IMSCT in adults. Gangliogliomas are very ra re 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 aff ected. Pain is the most common presenting symptom with weakness, gait deter ioration, torticollis also frequently reported. Hydrocephalus occurs with g reater frequency than in adult patients and often requires a shunt. Motor a nd 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 result s in surgical cure. Astrocytomas are infiltrating neoplasms and gross total resection is occasionally possible only in the pediatric population. Howev er, the role of radical resection of low-grade fibrillary astrocytomas of t he spinal cord in children has not been definitively demonstrated in the li terature. Outcome for low-grade astrocytomas is better in children than adu lts, but not as favorable as that for ependymomas. Malignant tumors have di smal outcomes and surgery in these patients serves only to provide a diagno sis.