Epidural Neuroblastoma

Neuroblastoma is the most common malignancy to cause spinal cord or nerve root compression in children (Conrad et al. 1992; de Bernardi et al. 2001) and may be a complication of loco-regional or metastatic disease. Extension into neural foramina and/or the spinal canal occurs in 10-15% of cases (Plantaz et al. 1996; Massad et al. 1985). Cord compression may manifest as radicular pain (back,neck,leg),weakness or gait disturbance, subacute or acute paraplegia, bowel or bladder dysfunction, sensory abnormalities, or scoliosis, although one-quarter of children with documented epidural disease are asymptomatic at presentation (Sandberg et al. 2003). Prompt resolution of spinal cord compression may prevent the development of permanent neurologic impairment. Several studies have indicated that the rate of neurologic recovery is related to both the severity and duration of neurologic symptoms at the time of diagnosis (Plantaz et al. 1996; Hoover et al. 1999; Plantaz et

Table 13.1. Treatment and neurologic outcomes for neuroblastoma patients with metastatic (group 1) or locoregional (group 2) epidural tumor

Reference Institution No.of No.of Initial treatment Initial treatment Outcome patients patients with for group 1 for group 2

neurologic deficits

Hoover et al. (1999)

MSKCC (1987-1998)

de Bernardi etal.2001)

(1967-1994) Multi-center

Plantaz Institute et al. (1993) Gustave Roussy (1982-1987)

26 (20 patients group 2,6 patients group 1)

0 0

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