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The Current Management of
Intramedullary Neoplasms in Children and Young Adults
George
I Jallo MD, Bong-Soo Kim MD, and Fred Epstein MD
Division of Pediatric Neurosurgery, Institute
for Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York
10028
Correspondence/Reprint
Author: George Jallo MD, Division
of Pediatric Neurosurgery, Institute for
Neurology and Neurosurgery, Beth Israel Medical Center, 170 East End Avenue,
New York, NY 10028. Tel
(212) 870-9600, Fax (212) 870-9665. E-mail: gjallo@bethisraelny.org
Aim.
The authors discuss the current management of intramedullary spinal cord tumors
in children and young adults.
Intramedullary spinal cord tumors of the pediatric population are rare
and comprise only a small percentage of all central nervous system neoplasms.
There has been much controversy with the surgical management of these
tumors.
Methods.
The majority of these neoplasms are histologically benign with large percentage
being astrocytomas or gangliogliomas.
Ependymomas, which are common in adults, are relatively rare in children.
The majority of these neoplasms occur in the cervical region with pain or a
motor deficit as the chief complaint.
Surgery on these neoplasms can be performed with safety using surgical adjuncts
such as the ultrasonic aspirator, contact laser and neurophysiological
monitoring.
Results.
A radical resection of these tumors results in a good long-term outcome, since
the majority is histologically benign.
Adjuvant radiation therapy should only be administered for the high grade or
malignant tumor.
Malignant tumors have a dismal outcome and surgery in these patients should be a
conservative debulking.
Spinal deformity is a concern in these children as a 35% of children may require
a stabilization procedure.
Conclusion.
Radical surgery for intramedullary neoplasms with the avoidance of
adjuvant radiotherapy results in long-term survival with minimal morbidity.
Copyright
Annals of Neurosurgery and Jallo GI
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