The clinical outcome and surgical treatment of 34 pediatric spinal tumors seen over an 18-year period (1981-1999) were analysed in a retrospective study at the Neurosurgical University Hospital of Frankfurt am Main, Germany. Tumor types and histology included the following: Intramedullary 5 (ependymoma, astrocytoma, hemangioblastoma): Intradural, extramedullary 6 (neurinoma, neurofibroma, medulloblastoma metastasis); Extramedullary, extradural 3 (neurinoma, ganglioneuroma); Extradural 6 (histiocytoma, neurinoma, angiofibroma, aneurysmal bone cyst); Extradural, paravertebral 14 (chordoma, primitive neuroectodermal, neuroblastoma, neurofibroma, Ewing”s sarcoma, aneurysmal bone cyst). Neurinomas and neurofibromas predominated in older children and neuroblastomas or primitive neuroectodermal tumors in younger age groups. Ependymomas and astrocytomas were the most frequent intramedullary tumors. Extradural tumors were more heterogeneous. Pain was the most frequent symptom, occurring in 67% of cases. Weakness of the extremities was the most common sign, elicited in 25 cases. Sensory impairment occurred in 22 and bladder dysfunction in 7. Malignant tumors had a shorter duration of symptoms and higher incidence of neurologic deficits than benign tumors. Following surgical decompression of the spinal cord, the neurologic status improved, with good functional recovery in 23 patients while 5 had deteriorated at follow-up. Relapse occurred in 12 cases (histiocytomas, chordomas, medulloblastoma, and von Hippel-Lindau cervical hemangioblastoma). Chemotherapy was used postoperatively in 7 cases, radiation therapy in 6, and combined therapy in 4. One case of aneurysmal bone cyst diagnosed by biopsy was cured by radiation therapy alone. At follow-up, average 2 years, 22 children could walk without aids, 7 with aids, and 2 (histiocytomas) were non-ambulatory and plegic. [1]

COMMENT. The majority of spinal tumors require surgical decompression, and resection when possible. Aneurysmal bone cysts may respond to radiation.