The Current Management of Intramedullary Neoplasms in Children and Young Adults

AIM: The authors discuss the current management of intramedullary spinal cord tumors in children and young adults. Intramedullary spinal cord tumors of the pediatric population are rare and comprise only a small percentage of all central nervous system neoplasms. There has been much controversy with the surgical management of these tumors. METHODS: The majority of these neoplasms are histologically benign with large percentage being astrocytomas or gangliogliomas. Ependymomas, which are common in adults, are relatively rare in children. The majority of these neoplasms occur in the cervical region with pain or a motor deficit as the chief complaint. Surgery on these neoplasms can be performed with safety using surgical adjuncts such as the ultrasonic aspirator, contact laser and neurophysiological monitoring. RESULTS: A radical resection of these tumors results in a good long-term outcome, since the majority is histologically benign. Adjuvant radiation therapy should only be administered for the high grade or malignant tumor. Malignant tumors have a dismal outcome and surgery in these patients should be a conservative debulking. Spinal deformity is a concern in these children as a 35% of children may require a stabilization procedure. CONCLUSION: Radical surgery for intramedullary neoplasms with the avoidance of adjuvant radiotherapy results in long-term survival with minimal morbidity.