PEDIATRIC SPINAL TUMORS

We present the case of a 12-year-old boy, presenting with symptomatology of persistent lower thoracic back pain and lower extremities tingling. He underwent lumbar spine MRI which revealed the presence of a large intradural extramedullary tumor, with homogenous contrast uptake extending to levels T12 to L2. The tumor was significantly compressing the conus medullaris and was laterally displacing the cauda equina nerve roots, which also demonstrated arachnoiditis-like appearance caudally to the tumor. The patient underwent also whole neuraxis MRIs with and without contrast with no other pathology revealed.

Treatment included total surgical removal and tumor biopsy. The procedure was performed under continuous intraoperative neuromonitoring of the conus medullaris and cauda equina nerve roots. The patient was placed prone onto the operating table and after T12/L1/L2/L3 laminectomies, the dura was incised and the tumor visualized. Cerebrospinal fluid (CSF) sample was obtained and sent to cytology lab. The tumor was found to be firmly attached to the filum terminale, which was also infiltrated by the tumor. After neuromonitoring confirmation, the filum terminale was cauterized and incised, a maneuver which facilitated the total excision of the tumor. Watertight dura closure was performed, and the wound was closed in layers. Electrophysiological recordings were stable throughout the procedure. The patient emerged from anesthesia into the operating room and was extubated without any complication. He was then transferred to neurosurgical ward. He was able to walk and urinate in the first postoperative day and he was discharged home on the third postoperative day, with no neurologic deficit. On the second postoperative day he underwent lumbar spine MRI pre and post contrast, with no residual tumor demonstrated.

Biopsy revealed myxopapillary ependymoma WHO Grade 2. CSF cytologic examination was negative for malignant cells. After oncologist consultation, the young patient will need no supplementary treatment, and he will undergo scheduled follow-up spine MRIs for the following years.

Skull base tumor with concomitant fistula in a 3-year-old patient

We treated the rare case of a young boy who presented with a small skin lesion on the forehead between the orbits. This skin lesion had never been assessed until a few months ago when our young patient began suffering episodes of fluid effusion from the area. He underwent a brain MRI that revealed a benign skull base tumor (dermoid cyst) that had caused the bone to become thinner and had created a fistula to the patient’s nose. This is a very serious condition because it disrupts the isolation of the brain, from the external environment possibly resulting in a severe infection of the nervous system that may threatent the patient neurological integrity and even his/her life.

We performed a cunolox surgery that includes a craniotomy in the frontal and orbital area, and then completely removed the tumor as well as the fistula.

The young patient was discharged after only a few days of hospitalization in excellent neurological condition.