Description
The speaker discusses pediatric intramedullary spinal cord tumors, emphasizing that they are rarer than in adults and are most often astrocytomas or ependymomas. Pediatric cases typically present subtly, commonly with weakness, delayed walking, sphincter disturbances, or focal pain. Astrocytomas are usually large, multilevel thoracic tumors associated with syndromes such as NF1, NF2, and tuberous sclerosis. The preferred treatment is surgery with neuromonitoring, aiming for maximal safe resection; the speaker notes using D-waves, MEPs, and anal catheters, and avoiding plates during closure to preserve MRI follow-up quality. Outcomes for low-grade astrocytomas in children are generally good, especially with early surgery and gross total resection, while high-grade lesions may require postoperative radiotherapy. Chemotherapy remains unstandardized and its role is uncertain.
Ependymomas are described as more common in younger children, often associated with NF2, and potentially spreading via CSF or directly, so brain imaging is also needed. They often present with pain, and surgery can be more aggressive because these tumors tend to have a clear plane and gross total resection leads to excellent outcomes; postoperative radiation is usually unnecessary if resection is complete. The speaker also reviews rare pediatric spinal lesions such as dermoid/epidermoid tumors and lipomas, often associated with congenital malformations or prior dysraphism. These can be highly adherent and time-consuming, sometimes requiring staged surgery for very extensive lesions. Long operations may require breaks, careful anesthetic management, and sometimes planned staging to reduce morbidity. In summary, biopsy for diagnosis is important, surgery is the main treatment, high-grade tumors may need radiation, and long-term follow-up with serial scans is essential because recurrences can occur many years later.