Surgical outcomes of primary pediatric spinal cord tumors: A retrospective cohort.
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BACKGROUND: Pediatric primary spinal cord tumors are rare, accounting for approximately 6% of central nervous system neoplasms. Most published data come from high-income countries (HICs) with access to early diagnosis, intraoperative monitoring, and specialized neuro-oncology units. In low- and middle-income countries (LMICs), diagnostic and therapeutic resources are limited. This report summarizes the first cohort of pediatric cases from Pakistan, highlighting surgical outcomes and systemic challenges in a resource-constrained setting. METHODS: We conducted a retrospective cohort study of patients ≤18 years who underwent surgery for primary pediatric spinal tumors at a tertiary hospital in Karachi (2008-2025). Demographics, presentation, tumor location and compartment, histopathology, extent of resection, postoperative complications, adjuvant therapy status, mortality, recurrence/progression, and follow-up outcomes were extracted from records. RESULTS: Nineteen children were included (11 female; median age, 12 years). Lower-limb weakness (n = 11) and back pain (n = 7/15 with available data) were the most common presentations, with a median diagnostic delay of 90 days. Tumors were most often lumbar (n = 6), cervical (n = 5), or thoracic (n = 5). Among 13 patients with documented compartment data, 7 tumors were intramedullary, 4 were extramedullary/intradural or paramedullary, and 2 were intradural without further compartment specification. Ependymoma (n = 5) and astrocytoma (n = 4) predominated. Gross total resection (GTR) was documented in 10 patients and maximal safe/subtotal resection (MSR/STR) in 7. Postoperative complications were documented in 2/16 patients with available data. At the last follow-up, 5/12 patients with neurological follow-up improved, 5 remained stable, and 2 worsened. Mortality was documented in 5/17 patients with survival status available patient had recurrence after GTR, and 1 had progression after MSR/STR. CONCLUSION: Surgical management of pediatric primary spinal tumors in an LMIC tertiary center was feasible, with limited documented perioperative morbidity after data correction. However, small sample size, missing event-level data, and a short median follow-up of 4 months limit interpretation of recurrence, progression-free status, and mortality. Earlier diagnosis, standardized surveillance, multidisciplinary review, rehabilitation, infection prevention, and improved access to adjuvant therapy may help strengthen care pathways in resource-constrained settings.