Paediatric spinal tumours


graph LR
    A[Paediatric Spinal Tumors]
    
    subgraph B[EXTRA-DURAL]
        B1[Primary bone tumors]
        B2[Neuroblastoma]
        B3[Sarcoma]
        B4[Chordoma]
        B5[Lymphoma]
        B6[Mets]
    end
    
    subgraph C[INTRA-DURAL]
        C1[Schwannoma]
        C2[Neurofibroma]
        C3[Inclusion cysts]
    end
    
    subgraph D[INTRAMEDULLARY]
        D1[Astrocytomas]
        D2[Ependymomas]
        D3[Ganglioglioma]
        D4[Hemangioblastoma]
    end
    
    A --> B
    A --> C
    A --> D

Presentation

Motor deficits

Bulbar features

Pain

Night pain due to lying down

Sphincter disturbance

Deformity

Hydrocephalus

Procedure

Find midline

Laminectomy vs. Laminoplasty

Laminoplasty does not improve deformity rates but it helps with CSF leaks and helps with maintaining tissue plane for re-debulking

Duraplasty

Expansion Duraplasty without laminoplasty: used for palliative tumour (high grade astrocytoma) to allow tumour to expand

Debulking vs. Resection

Surgical resection is the mainstay of treatment for IMSCT in children
Modify technique in some circumstances

No role for radical surgery in high-grade tumors

Intraoperative USS and IOM increase the safety and efficacy of surgery

If Loose MEP but D waves working 50% of temporary motor deficit present

Intramedullary tumours

Ganglioglioma hard to differentiate vs normal cord.
Ependymoma: caping cyst has better interface as it is arising from the ependyma
Astrocytoma: poorer interface

10% has HCP

Due to proteineous CSF and seeding of tumour

Oncological results are good, spinal morbidity can be significant