Pediatrik Spinal Kitlelerin Retrospektif Analizi

Yıl 2023, , 291 - 296, 31.12.2023

Oğuz Altunyuva , Pınar Eser Ocak , Şeref Doğan , M Özgür Taşkapılıoğlu

https://doi.org/10.32708/uutfd.1308870

Öz

Pediatrik spinal tümörler tüm pediatrik santral sinir sistemi tümörlerinin %10’undan azını oluşturmaktadır. Sıklıkla metastatik vasıfta olan bu tümörler spinal korda bası yaparak nörolojik defisite ve dolayısı ile morbiditeye neden olmaktadırlar. Erken tanı ve tedavi hasta sağ kalımını önemli oranda etkilemektedir. Çalışmamızda kliniğimizde Mayıs 2010– Kasım 2021 tarihleri arasında opere edilen pediatrik yaş grubundaki spinal kitleli olgular retrospektif incelendi. 47 pediatrik spinal kitle olgusu (26 E, 21 K) değerlendirildi. 24 (%51) olguda kitle ekstradural, 13 (%27,7) olguda intradural ekstramedüller, 10 (%21,3) olguda ise intramedüller yerleşimliydi. En sık başvuru semptomu 41 (%87,2) olgu ile ağrı idi. 4 (%8,5) olguda biyopsi, 12 (%25,5) olguda subtotal eksizyon, 31 (%66) olguda total eksizyon yapıldı. En sık patolojiler; intradural ekstramedüller yerleşimli (n=8; %17) dermoid-epidermoid tümör, ekstradural yerleşimli (n=7; %14,9) Ewing sarkomu ve intramedüller yerleşimli (n=6; %12,8) astrositoma olarak izlendi. Toplamda 7 (%14,9) olguya adjuvan kemoterapi; 1 (%2,1) olguya ise radyoterapi; 12 (%25,6) olguya ise kombine kemoradyoterapi prosedürü uygulandı. Ortalama 37,3± 32,7 ay olan takip süresi boyunca 7 (%14,9) olgu nüks/rezidü tümör, 3 (%6,4) olgu ise yara yeri enfeksiyonu sebebiyle tekrar opere edildi. Pediatrik spinal tümörler neden olduğu morbiditeler, geç tanı konması ve dolayısıyla da erken ve etkili tedavi gerekliliği açısından nöroşirürji pratiğinde önemli bir yere sahiptir. Tedavi şekli tümörün patolojik tanısına göre yapılır ancak cerrahi rezeksiyon esastır. Etkin tedavi modalitelerinde cerrahinin yanı sıra adjuvan kemoterapi ve radyoterapi birlikte kullanılmalıdır.

Anahtar Kelimeler

Pediatrik spinal tümör, Ependimoma, Astrositoma, Ewing Sarkomu, Nöroblastoma

Retrospective Analysis of Pediatric Spinal Tumors

Öz

Pediatric spinal tumors account for less than 10% of all pediatric central nervous system tumors. These tumors, which are frequently metastatic, cause neurological deficit and morbidity by compressing the spinal cord. Early diagnosis and treatment significantly affect patient survival. In our study, patients with spinal tumors in the pediatric age group who were operated in our clinic between May 2010 and November 2021 were analyzed retrospectively. 47 pediatric spinal tumor cases (26M, 21F) were evaluated. The tumor was extradural in 24 (51%), intradural extramedullary in 13 (27.7%), and intramedullary in 10 (21.3%) cases. The most common presenting symptom was pain with 41 (87.2%) cases. Biopsy was performed in 4 (8.5%), subtotal excision was performed in 12 (25.5%), and total excision was performed in 31 (66%) cases. The most common pathologies were as follows: Intradural extramedullary localization (n=8; 17%) dermoid-epidermoid tumor, extradural localization (n=7; 14.9%) Ewing sarcoma and intramedullary localization (n=6; 12.8%) astrocytoma. Adjuvant chemotherapy in 7 (14.9%); Radiotherapy in 1 (2.1%); combined chemoradiotherapy procedure was applied to 12 (25.6%) cases. During the mean follow-up period of 37.3±32.7 months, 7 (14.9%) cases were reoperated for recurrent/residual tumors and 3 (6.4%) for wound infection. Pediatric spinal tumors have an important place in neurosurgery practice in terms of the morbidities they cause, late diagnosis and therefore the need for early and effective treatment. The treatment method is based on the pathological diagnosis of the tumor, but surgical resection is essential. In addition to surgery, adjuvant chemotherapy and radiotherapy should be used together in effective treatment modalities.

Anahtar Kelimeler

Pediatric spinal tumors, Ependymoma, Astrocytoma, Ewing Sarcoma, Neuroblastoma

Kaynakça

• 1. Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Patient Version. PDQ Pediatric Treatment Editorial Board. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002. 2021 Jan 12.
• 2. Hani U, Tebha SS, Bakhski SK, Shamim MS. Intramedullary spinal cord lesions in children. J Park Med Assoc. 2021; 71(2(B)):775-7.
• 3. Huisman TAGM. Pediatric tumors of the spine. Cancer Imaging. 2009; 9 Spec No A(Special Issue A):S45-8.
• 4. Graham GN, Browne H. Primary bony tumors of the pediatric spine. Yale J Biol MEd. 2001; 74(1):1-8.
• 5. Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Herhangi BS. Intraoperative neuromonitoring in patients with intramedullary spinal cord tumor: A systematic review, meta-analysis and case series. World Neurosurg. 2019; 125:498-510.
• 6. Marazzo A, Cacchione A, Rossi S et al. Intradural pediatric spinal tumors: An overview from imaging to novel molecular findings. Diagnostics (Basel). 2021; 18:11(9):1710.
• 7. Massimi L, Chaves TMF, Sop FYL, Frassanito P, Tamburrini G, Caldaralli M. Acute presentations of intradural lipomas: case reports and a review of tje literatüre. BMC Neurol. 2019; 19(1):189.
• 8. Wang K, Zhao J, Zhang Y, Su Y. Pediatric intramedullary schwannoma with syringomyelia: a case report and literatüre review. BMC Pediatr. 2018; 18(1):374.
• 9. Luzzati A, Scrotto G, Cannavo L et al. En bloc resection in patients younger than 16 years affected by primary spine tumors: indications, results and complications in a series of 22 patients. Eur Spine J. 2020; 29(12):2135-47.
• 10. Müngen E, Kurucu N, Kutluk T, Oğuz KK, Söylemezoğlu F, Yalçın B. Primary spinal multifocal intradural-extramedullary Ewing sarcoma in children: Presentation od a case and review of the literatüre. Turk J Pediatr. 2021; 63(6):1084-90.
• 11. Chen CW, Chen IH, Hu MH et al. Primary intradural extramedullary spinal mesenchymal chondrosarcoma: case report and literatüre review. BMC Musculoskelet Disort. 2019 Sep 4; 20(1):408.
• 12. Egiz A, Kannan S, Asl SF. The impact of surgical resection and and adjuvant therapy on survival in pediatric patients with atypical teratoid/rabdoid tumor: Systematic review and pooled survival analysis. World Neurosurg. 2022; 164:216-27.
• 13. Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Health Professional Version. PDQ Pediatric Treatment Editorial Board. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002. 2021 Oct 8.
• 14. Joaquim AF, Ghizoni E, Valadares MGC, Appenzeller S, Aguiar SDS, Tedeschi H. Spinal tumors in children. Rev Assoc Med Bras. 2017; 63(5):459-65.
• 15. Berrman R, Kliegman RM, Arvin AM. Nelso’s textbook of pediatrics, 15th edn. Philedelphia:W.B. Saunders Company; 1996.
• 16. Beer SJ, Menezes AH. Primary tumors of the spine in children: Natural history, management, and long-term follow-up. Spine. 1976; 22(6):649–58.
• 17. Fenoy AJ, Greenlee JD, Menezes AH et al. Primary bone tumors of the spine in children. J Neurosurg. 2006; 105(4 Suppl):252–60.
• 18. Azad TD, Pendharkar AV, Pan J et al. Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis. J Neurosurg Pediatr. 2018; 22(4):404-10.
• 19. Crawford JR, Zaninovic A, Santi M et al. Primary spinal cord tumors of childhood: Effects of clinical presentatiton, radiographic features and pathology on survival. J Neurooncol. 2009; 95(2):259-69.
• 20. Abrar W, Sarmast A, Singh ARS, Khursheed N, Ali Z. Aneurysmal bone cysts of spine: An enigmatic Entity. Neurol India. 2020; 68(4):843-49.
• 21. Weber MA, Bazzocchi A, Nöbauer-Huhmann IM. Tumors of the spine: When can biopsy be avoided?. Semin Musculoskelet Radiol. 2022; 26(4):453-68.
• 22. Oya J, Burke JF, Vogel T, Tay B, Chou D, Mummaneni P. The accuracy of multimodality intraoperative neuromonitoring to predict postoperative neurologic deficits following cervical laminoplasty. World Neurosurg. 2017;106:17–25.
• 23. Siller S, Szelényi A, Herlitz L, Tonn JC, Zausinger S. Spinal cord hemangioblastomas: significance of intraoperative neurophysiological monitoring for resection and long-term outcome. J Neurosurg Spine 2017;26(4): 483–93.
• 24. Wang L, Li T, Gong M et al. Intramedullary cervical spinal cord teratoma. Medicine (Baltimore). 2020; 99(18)e20107.
• 25. Smith MA, Seibel NL, Altekruse SF, et al. Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol. 2010; 28(15):2625-34.
• 26. Reimers TS, Mortensen EL, Nysom K, Schmiegelow K. Health-related quality of life in long-term survivors of childhood brain tumors. Pediatr Blood Cancer. 2009; 53(6):1086-91.
• 27. Iuvone L, Peruzzi L, Colosimo C, et al. Pretreatment neuropsychological deficits in children with brain tumors. Neuro Oncol. 2011; 13(5):517-24.
• 28. Bellut D, Burkhardt JK, Mannion AF, Porchet F. Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale. Neurosurg Focus. 2015; 39(2):E2.
• 29. Bansal S, Suri A, Borkar SA, Kale SS, Singh M, Mahapatra AK. Management of intramedullary tumors in children: analysis of 82 operated cases. Childs Nerv Syst. 2012;28:2063-9.