Pediatric Spinal Cord Tumors

Abstract

Pediatric spinal cord tumors comprise a rare but challenging subset of neoplasms with regards to neurosurgical and neuro-oncologic management. Spinal cord tumors may present with more common findings of weakness or back pain in older children or with more subtle findings of early handedness or head tilt in younger children and infants. An understanding of the diverse presentation of pediatric spinal cord tumors, their radiographic features and management strategies is crucial as delayed diagnosis may affect clinical outcome. While the vast majority of pediatric spinal cord tumors are histologically benign, their anatomic location often makes them a challenge to treat, both surgically and medically, as there is no universal consensus of the management of these children. Gross total surgical resection is the mainstay of therapy whenever feasible, however, intramedullary tumors pose a unique set of challenges for the neurosurgeon. Adjuvant chemotherapy plays a lesser role in the management of spinal cord tumors compared to their cerebral counterparts. Radiation therapy is a very important adjuvant therapy in the treatment of spinal cord tumors. However, depending on the age of the child and extent of radiation field, this may carry future risks of scoliosis or future secondary malignancy. There has been a relative lack of progress in non-surgical management of children with spinal cord tumors. The rarity of pediatric spinal cord tumors, together with small tissue sizes obtained during surgery portends a lesser understanding of the biologic mechanism of this disease. In this chapter, we will present the most common pediatric spinal cord tumors, their clinical and neuroradiographic features, as well as tumor biology and treatment strategies.