Complications of Treatment of Intramedullary Spinal Cord Tumors in Children

Surgical

General complications – Agency for Healthcare Research and Quality

• 8.9% overall incidence in patients younger than 18 years: The incidence of postoperative complications in patients younger than 18 years operated on for IMSCTs in the United States was reported as 8.9% between 1993 and 2003 (39). About 40% experienced urinary tract complications, 20% wound hematomas, and 20% pulmonary complications.

Constantini/Epstein series (10)

• No operative mortalities
• Hydrocephalus: Hydrocephalus requiring placement of a shunt developed in 18% of patients.
• Functional loss: Functional loss was experienced by 24% of the patients as measured by the McCormick Scale.  The majority deteriorated by one grade, with only 13 experiencing a loss of more than one grade. Most of those losing function were not in good functional condition before their surgery.
• Urinary dysfunction: 40% of the children in the series had urinary dysfunction, while 25% of the children in the series had frank incontinence.
• Dysesthesia: Dysesthesia was seen in 60% but was painful in only 6% of the 164 children and young adults in the series.

Other surgical complications

• Proprioceptive loss:  In older children and adolescents proprioceptive loss can be quite debilitating.  It is a frequent problem when operating on IMSCTs in the cervical cord.
• Wound leakage: Wound leakage creates several potential problems. It risks infection, which can seriously compromise functional recovery; and it can require reoperation, with the attendant stresses that are placed on the recovering spinal cord. Drains can be helpful in minimizing the stress of CSF on the healing muscle incision, allowing it to heal to the point where it is an effective CSF barrier. Late (1 week or more after surgery) leakage may signal the development of hydrocephalus.

Radiation

• Myelopathy and stunted growth with radiation: Myelopathy and stunted growth have been reported in children who have had their spine irradiated. It is unclear if newer forms of delivery of radiation will lessen these problems (47).