DISCUSSION
Approximately 10% of all pediatric central nervous neoplasms are
located in the spinal cord, either intramedullary or
extramedullary.3 It is estimated that 90% of
intramedullary spinal cord masses are glial tumors.4These mainly include astrocytoma and ependymoma.5 All
age groups be can be affected by these neoplasms; however, they occur
more frequently in children less than 10 years of age. Overall, males
and females are equally affected.5 The growth of the
spinal cord tumors are slow, and symptoms are usually nonspecific, which
is the reason why these tumors are frequently diagnosed at later
stages.5 Patients typically have symptoms that tend to
evolve over months to years. Most commonly, regional back pain is the
complaint at first presentation.6
Fortunately, low-grade tumors comprise most spinal cord tumors. However,
high-grade lesions account for only ten to fifteen percent of pediatric
tumors, and they tend to occur in a slightly higher proportion in
adults.6
Astrocytomas are slow-growing tumors. Typically, the interval between
the onset of symptoms and the time of diagnosis is long and might take
months or even years.6 Two thirds of the patients
reported diffuse back pain as the initial manifestation. The pain they
described was worse with lying down, causing nighttime
symptoms.1,5
In France between 1971 and 1994, a review of 73 cases of spinal cord
astrocytoma in pediatrics revealed that back pain was the most common
presentation (89%), while 78% noticed to have gait abnormalities and
32% developed weakness in the upper limbs or sphincter disturbances.
Fewer than 10% of the symptoms were headache and muscle
weakness.3
Our patient did not initially present with back pain but rather with
abdominal pain and with leaning forward while walking.
Regarding the modality of choice for diagnosis, MRI has excellent
soft-tissue contrast. At the same time, it lacks ionizing radiation
making it safe for children. There is still a debate about the treatment
of many of these neoplasms. Still, the best option indicated by the
current evidence is microsurgical resection, with adjunctive treatment
being reserved in cases of recurrent or high-grade
lesions.7