Pediatrik Spinal Kitlelerin Retrospektif Analizi

Year 2023, Volume: 49 Issue: 3, 291 - 296, 31.12.2023

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

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

Abstract

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.

Keywords

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

Retrospective Analysis of Pediatric Spinal Tumors

Abstract

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.

Keywords

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

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