Pediatric Intramedullary Teratomas

Işık, Nihal; Balak, Naci; Sılav, Gökalp; Elmacı, İlhan

doi:10.1055/s-0028-1112116

Cited by 18 publications

(18 citation statements)

References 22 publications

(27 reference statements)

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“…10,14,45 Resection is the initial step in the management for IMSCTs followed by adjuvant therapy in some cases. 5,13,15,16,18,33 …”

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confidence: 99%

Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

Cheng¹,

Ivan²,

Stapleton³

et al. 2014

PED

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Object Intraoperative dorsal column mapping, transcranial motor evoked potentials (TcMEPs), and somatosensory evoked potentials (SSEPs) have been used in adults to assist with the resection of intramedullary spinal cord tumors (IMSCTs) and to predict postoperative motor deficits. The authors sought to determine whether changes in MEP and SSEP waveforms would similarly predict postoperative motor deficits in children. Methods The authors reviewed charts and intraoperative records for children who had undergone resection for IMSCTs as well as dorsal column mapping and TcMEP and SSEP monitoring. Motor evoked potential data were supplemented with electromyography data obtained using a Kartush microstimulator (Medtronic Inc.). Motor strength was graded using the Medical Research Council (MRC) scale during the preoperative, immediate postoperative, and follow-up periods. Reductions in SSEPs were documented after mechanical traction, in response to maneuvers with the cavitational ultrasonic surgical aspirator (CUSA), or both. Results Data from 12 patients were analyzed. Three lesions were encountered in the cervical and 7 in the thoracic spinal cord. Two patients had lesions of the cervicomedullary junction and upper spinal cord. Intraoperative MEP changes were noted in half of the patients. In these cases, normal polyphasic signals converted to biphasic signals, and these changes correlated with a loss of 1–2 grades in motor strength. One patient lost MEP signals completely and recovered strength to MRC Grade 4/5. The 2 patients with high cervical lesions showed neither intraoperative MEP changes nor motor deficits postoperatively. Dorsal columns were mapped in 7 patients, and the midline was determined accurately in all 7. Somatosensory evoked potentials were decreased in 7 patients. Two patients each had 2 SSEP decreases in response to traction intraoperatively but had no new sensory findings postoperatively. Another 2 patients had 3 traction-related SSEP decreases intraoperatively, and both had new postoperative sensory deficits that resolved. One additional patient had a CUSA-related SSEP decrease intraoperatively, which resolved postoperatively, and the last patient had 3 traction-related sensory deficits and a CUSA-related sensory deficit postoperatively, none of which resolved. Conclusions Intraoperative TcMEPs and SSEPs can predict the degree of postoperative motor deficit in pediatric patients undergoing IMSCT resection. This technique, combined with dorsal column mapping, is particularly useful in resecting lesions of the upper cervical cord, which are generally considered to be high risk in this population. Furthermore, the spinal cord appears to be less tolerant of repeated intraoperative SSEP decreases, with 3 successive insults most likely to yield postoperative sensory deficits. Changes in TcMEPs and SSEP waveforms can signal the need to guard against excessive manipulation thereby increasing the safety of tumor resection.

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“…10,14,45 Resection is the initial step in the management for IMSCTs followed by adjuvant therapy in some cases. 5,13,15,16,18,33 …”

mentioning

confidence: 99%

Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

Cheng¹,

Ivan²,

Stapleton³

et al. 2014

PED

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“…5,11 Teratomas comprise 3% of all pediatric tumors and 0.1% of all CNS tumors. 8 Only 0.2%-0.5% of CNS terato- mas occur in the spinal cord. 13 In a recent review, Işik et al 8 identified 16 reported cases of intramedullary teratomas in children.…”

Section: Discussionmentioning

confidence: 99%

“…8 Only 0.2%-0.5% of CNS terato- mas occur in the spinal cord. 13 In a recent review, Işik et al 8 identified 16 reported cases of intramedullary teratomas in children. Of these, only 1 was designated as "immature.…”

Section: Discussionmentioning

confidence: 99%

“…19 Teratomas of the CNS are composed of tissues derived from all 3 germ cell layers and, following the schema for teratomas outside the CNS, are categorized as mature, immature, and malignant. 8 Mature teratomas are composed solely of tissue elements that are appropriately developed for patient age. These tissues include bone, nerve, cartilage, adipose tissue, striated and smooth muscle, pancreas, liver, skin with associated appendages, enteric mucosa, and respiratory mucosa.…”

Section: Discussionmentioning

confidence: 99%

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Intramedullary spinal immature teratoma: resolution of quadriplegia following resection in a 4-week-old infant

Nickols

Chambless²,

Carson

et al. 2010

PED

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Intramedullary spinal cord teratomas are rare entities in infants. Management of these lesions is primarily surgical, with outcome dependent on rapid surgical decompression and complete gross-total tumor resection. The lesions are typically of the mature type, with immature teratomas displaying unique pathological features. The authors report a case of an extensive intramedullary immature teratoma in an infant with resolution of quadriplegia following grosstotal radical resection. At the 1-year follow-up, there was radiographic evidence of tumor, and surgical reexploration yielded portions of immature teratoma and extensive gliosis.

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“…However, teratomas of the central nervous system (CNS) are especially rare and account for only 0.1% of all CNS tumors 6. Spinal cord teratomas are even rarer and can be present in extradural, intradural, or intramedullary locations 7.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Epidural Teratoma: Case Report and Review of the Literature

Quon

Grant

Hüttner³

et al. 2014

Clin Med�Insights�Pathol

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PURPOSESpinal teratomas comprise a rare subset of spinal cord tumors, and here, we describe an even rarer childhood thoracic extradural–intracanalicular teratoma. The clinical presentation, management, and pathophysiology of these tumors are reviewed to promote recognition and guide treatment of these lesions.METHODSWe report the case of a 21-month-old boy who presented with marked spasticity, as well as failure to ambulate and meet motor milestones. Additionally, we provide a literature review of spinal teratomas, including their clinical presentation, work-up, pathophysiology, and underlying genetics.ResultsAn MRI of the spine revealed a large dorsal epidural tumor extending from T3 to T10 with heterogeneous contrast enhancement and severe spinal cord compression. The tumor was resected revealing a cystic mass with tissue resembling hair, muscle, as well as cartilage; pathology confirmed the diagnosis of teratoma. Gross total resection was achieved, and the child eventually gained ambulatory function.CONCLUSIONSGiven that spinal teratomas are rare entities that can present with significant neurologic compromise, they must remain on clinicians’ differentials. Unfortunately, the exact origin of these tumors remains inconclusive and requires further investigation.

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Pediatric Intramedullary Teratomas

Cited by 18 publications

References 22 publications

Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

Intramedullary spinal immature teratoma: resolution of quadriplegia following resection in a 4-week-old infant

Thoracic Epidural Teratoma: Case Report and Review of the Literature

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