Primary Tumors of the Spine in Children – Natural History and Management

Menezes, Arnold H.; Sato, Yutaka

doi:10.1159/000120945

Cited by 15 publications

(11 citation statements)

References 26 publications

(41 reference statements)

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“…Pain was the main presenting complaint in our series (87.5%) as seen in the data of Raffel [9] (61%), Schick and Marquardt[ 12] (67%) and Menezes and Sato [5]. It was either the localized back pain, radicular pain or pain that worsens on movement irrespective of the pathology whether benign or malignant.…”

Section: Discussionmentioning

confidence: 59%

“…Roughly, 40% tumors occur in the intramedullary location, 10% in the intradural extramedullary and 50% in the extradural location in children if metastatic cancer is excluded [3]. Pediatric extradural tumors comprise benign lesions like osteoid osteoma, osteoblastoma, giant cell tumors, aneurysmal bone cyst, vertebral hemangioma, fibrous dysplasia, eosinophilic granuloma as well as schwanomma and so called embryonal tumors like: epidermoid, dermoid tumors, teratomas and lipomas [4, 5]. Rare occurrence of parasitic bony cyst or histiocytosis is also noted.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Extradural Spinal Tumors

Kumar

Giri²

2008

Pediatr Neurosurg

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We have reviewed 16 children with extradural spinal tumors, both benign and malignant, treated from 1998 to 2006 in Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. The duration of symptomatology, clinical signs, radiological investigations, surgical approach, outcome and histopathological variation from the Western world was noted and evaluated. The age of these children ranged from 3 to 20 years. There were 11 boys and 5 girls. The duration of symptoms was 2–18 months, relatively longer in benign (mean 9.5 months) than malignant (mean 4.2 months) tumors. The follow-up ranged from 3 to 72 months and patients were graded preoperatively and postoperatively with the McCormick Functional Grading System. There was significant improvement in grade III–V patients, i.e. 74% of patients were grade III–IV at presentation, and only 35% at the last follow-up. There was deterioration from grade III to grade IV in 2 patients (PNET + metastatic adenocarcinoma) and 2 patients (neuroblastoma + Ewing’s sarcoma) maintained their grades of IV and V, respectively. There was a wide range of histological variants seen in our series and the patients were treated primarily with a suitable surgical approach and adjuvant chemoradiotherapy, wherever indicated.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Pediatric Extradural Spinal Tumors

Kumar

Giri²

2008

Pediatr Neurosurg

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“…We demonstrated successful tumor control by complete intralesional resection. 42 In 1996, Piper and Menezes presented surgical management strategies for tumors of the axis in adults and children. 56 The approaches were as follows: 1) the anterior transoral-transpalatopharyngeal route (Zone 1), with exposure from a facet joint to the opposite facet joint; 2) the lateral extrapharyngeal route, with the same exposure but from an anterolateral approach going onto the foramen transversarium (Zone 2); 3) the posterolateral approach with vertebral artery rerouting that exposes the foramen transversarium and both laminae up to the foramen transversarium on the side of approach (Zone 3); and 4) the midline approach from a dorsal aspect, which provides exposure between the right and left facets (Zone 4).…”

Section: Discussionmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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“…Turner et al [11] reported that more than 50% of children aged 15 or younger with nontraumatic back symptoms have a specific diagnosis. Similarly injuries superimposed on a spine already compromised by neoplastic disease may cause signs and symptoms out of proportion to those expected in an intact skeleton [12]. In our patients, the mean time from onset of symptoms to diagnosis was 1 week to 18 months (average = 6 months), and this interval did not change between the malignant and benign groups.…”

Section: Discussionmentioning

confidence: 65%

“…Therefore, a high index of suspicion in the pediatric patients with back pain is essential for diagnosis [15]. However, pain may be insidious in onset and mild, and spinal tumors are extremely rare so that tumor diagnosis is often unsuspected, and the delay before seeking medical attention averages many months [12, 15]. In our series, a neurological deficit was detected in 58.3% of the tumors at the time of the initial clinical examination (66.6% for malignant ones and 55.5% for benign ones).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Vertebral and Spinal Epidural Tumors: A Retrospective Review of Twelve Cases

Güzey¹,

Emel²,

Abakay³

et al. 2007

Pediatr Neurosurg

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Objective: Pediatric vertebral tumors are rare, and most of the reported series have limited numbers of cases. Diagnosis of these tumors is difficult because of the patients’ age and the rarity of the lesions. We aimed to report the clinical, radiological and pathological characteristics in a small series of pediatric vertebral and spinal epidural tumors and to discuss diagnostic and treatment difficulties. Materials and Methods: Twelve consecutive pediatric cases with vertebral or spinal epidural tumors were reviewed retrospectively. Results: The mean age was 12.6 years, and male and female patients were equal in number. The most common symptom was pain. There were some neurological or local findings in all patients, and there were some positive results on plain radiographs in all cases except 2. The tumors were removed totally in 9 cases. There were histologically malignant lesions in 3 and benign lesions in 9 cases. Three patients with malignant tumors were treated by radiotherapy and 2 by chemotherapy. One patient with thoracic hemangioma was also treated by embolization after surgery. One case with cervical Dabska’s tumor died due to air embolization. The other patients were followed for 48.3 months. The preoperative neurological deficits were resolved completely in all patients except the one with only biopsy performed at the last follow-up. There were no new spinal deformities on follow-up. Conclusion: Children with vertebral tumors and spinal epidural tumors usually present with pain and neurological deficits or local findings, and there are some indications on plain radiographs. Therefore, a careful physical examination and detailed evaluation of radiographs may minimize the rate of misdiagnosis and underestimation. Most of these tumors are benign, therefore, their outcome is good, and cure may be possible for many of the cases.

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Primary Tumors of the Spine in Children – Natural History and Management

Cited by 15 publications

References 26 publications

Pediatric Extradural Spinal Tumors

Pediatric Extradural Spinal Tumors

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Pediatric Vertebral and Spinal Epidural Tumors: A Retrospective Review of Twelve Cases

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