Acta Neurochir (Wien) (1993) 120:59-65 :Acta NTdurochirurgica ,D Springer-Verlag 1993 Printed in Austria Management of Intramedullary Tumours in Children P. Lunardi, G. Licastro, P. Missori, L. Ferrante, and A. Fortuna Department of Neurological Sciences, Neurosurgery, University of Rome "La Sapienza", Rome, Italy Summary Clinical presentation, diagnosis, surgical technique and results of 25 cases of intrameduIIary tumours in patients under 16 years of age are analyzed. Pre-operative spinal deformity was present in 9 patients. Surgery was performed in all. After multilaminectomy with preservation of the intervertebral joints, total removal of the lesion was achieved in 11 patients and subtotal removal in 14 others. After surgery, external immobilization lasting an average period of 5 years was instituted in all patients. Postoperative radiation therapy was performed in 11 cases (5 "high grade" astrocytomas, 5 ependymo- mas, 1 glioblastoma). There were 11 recurrences: 4 of which (2 ependymomas and 2 "low grade" astrocytomas) were treated sur- gically, 7 (5 "high grade" astrocytomas, 1 glioblastoma, 1 oligo- dendroglioma) with palliative radiation treatment. Six patients even- tually developed postlaminectomy spinal deformities as diagnosed roentgenographically 6 to 50 months postoperatively. Of the 16 pa- tients still alive, 7 did not present relevant neurological deficit, 1 presented a monoparesis, while the other 8 presented invalidating deficits. Surgical treatment did not differ from that employed in the intramedullary tumours in the aduIt: radical resection is indeed the optimal therapeutic origin. The risk of radiation therapy are greater in children: it is crucial to limit radiation therapy to only some histotypes. The incidence of spinaI column deformity after multilevel laminectomy is greater in young patients. It is advisable to implement prevention of spinal deformities by postoperative external immo- bilization and constant follow-up so as to detect early changes of spinal stability. Keywords: Intramedullary tumours; management; results; lami- nectomy; spinal deformities. Introduction The ratio of intramedullary tumours with respect to intracranial ones is, in the adult, of about 1 : 52, 5,32,35,36. In the paediatric age group such ratio varies from 1 : 20 to 1 : 5 according to the different oncotypes. As in the adult, the most frequent intramedullary tumour his- totypes are represented by the astrocytomas and epen- dymomas, which constitute 80-90% of all intrame- dullary tumours. Metameric distribution is the same in both age groups, except for the cervical segments, whereas in children there is a greater incidence of as- trocytomas and minor incidence of ependymomas 2' 15, 17, 18, 29, 55 Summary of Cases Incidence and Categorization 25 cases of primitive intramedullary tumours pre- senting in patients under 16 years of age (14 males and 11 females) and treated at the Neurosurgery Ward of the University of Rome "La Sapienza" between 1970 and 1990 are reported. They represent 18% of all the tumours observed in the same time period. There was a 1.3 : 1 male to female ratio. The age group prevalently affected was the one from 10 to 16 years (Table 1). Table 1. Distribution by Age Age (years) Cases number percent 0-5 2 8 5-10 9 36 10--16 14 56 Table 2. Types of lntraspinal Tumours Tumour types Cases number percent Astrocytomas grade I-1I 9 45 grade III-IV 5 20 Ependymomas 9 45 Oligodendroglioma l 4 Gliobtastoma 1 4