Intraspinal tumor in children
Introduction
Introduction to pediatric spinal canal tumor Intraspinal tumors (intraspinal tumors) include various tumor-like lesions originating from different tissues in the spinal canal, such as the spinal cord, nerve roots, meninges or vertebrae. The incidence of intraspinal tumors in children is significantly lower than that in intracranial tumors. More common meningioma and neurofibromatosis are particularly rare in children, while tumors of embryonic residual tissue (epithelial cysts and dermoid cysts) occur in childhood, and intraspinal tumors can occur in any segment of the spine. The main clinical manifestations are the nerve root damage in the plane of the tumor and the symptoms and signs of long-beam involvement below this level. basic knowledge The proportion of children: the incidence rate of children is about 0.0002%-0.0003% Susceptible people: children Mode of infection: non-infectious Complications: torticollis scoliosis meningitis
Cause
Pediatric intraductal tumor cause
(1) Causes of the disease
The intraspinal tumor has primary or secondary tumors. The intraspinal tumor can occur in any segment of the spine. Because the thoracic segment is the longest, the incidence of the tumor is correspondingly higher. The segment of the spinal canal tumor in this group of children The distribution is 16.4% of the neck segment, 29.3% of the thoracic segment, and 20% of the lumbar segment; the lumbar segment and the lumbosacral segment account for 33.8%, which is much higher than that of the adult group, which is related to the pedicel residual tumor tissue in this part. .
Tumors located in the intramedullary and epidural are more common in adults, tumors are located in the intramedullary group accounted for about 1/4, and epidural accounts for 1/5. Various tumors have their own specific sites, such as dermoid cysts. And the skin-like cysts occur mostly in the lumbosacral segment. Glioma is more common in the thoracolumbar and thoracic segments. Sarcomas and ganglioneuromas are more common in the epidural. Intestinal cysts are subdural in the cervical subdural, and the ventral side of the spinal cord is more common, which can be complicated with myeloid cysts.
(two) pathogenesis
Tumors in the spinal canal compress the spinal cord and nerve roots, causing various neurological dysfunctions, compressing blood vessels, causing spinal cord edema, degeneration and necrosis, and causing varying degrees of spinal cord compression syndrome.
Prevention
Pediatric intraspinal tumor prevention
Understanding the risk factors of tumors, developing appropriate prevention strategies can reduce the risk of tumors, and there are two basic clues to prevent tumors. Even if tumors have begun to form in the body, they can help the body to improve resistance. These strategies are as follows:
1. Avoid harmful substances (promoting factors): It can help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors: can help to strengthen and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100u of vitamin E. It can be inferred that the antioxidant effect in fruits and vegetables is far better than what we know. The effect of vitamins is strong, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric intraspinal tumor complications Complications Inclined cervical scoliosis meningitis
May be associated with deformation of the spine bones and muscle atrophy, torticollis and scoliosis, combined with abnormal skin in the spine or midline, lack of lamina, recessive spina bifida, history of unexplained meningitis and spinal cord compression symptoms, etc. , tumor metastasis can occur.
Symptom
Pediatric intraspinal tumor symptoms common symptoms radioactive pain irritability spinal thalamus bundle compression ants walking gait instability spinal cord compression weakness meningitis bladder dysfunction hair abnormalities
1. General clinical manifestations: mainly the nerve root damage in the plane of the tumor and the symptoms and signs of long-beam involvement below this level.
(1) radicular pain: caused by stimulation of the nerve root or dura mater, the site is relatively fixed, often confined to one place, and radiated along the affected nerve root distribution area, such as knife cutting, acupuncture or burning, often Intermittent seizures are aggravated or induced when forced, coughing or sneezing. The incidence of this symptom is lower in infants and young children than in adult spinal cord tumors. Possible reasons are:
1 The incidence of extramedullary subdural tumors is low: the two types of extramedullary subdural benign tumors (meningioma and neurofibroma), which are most prone to radicular pain, have a lower incidence in childhood.
2 poor expression of pain: children with poor expression of the location and nature of the pain, only manifested as paroxysmal crying and irritability.
3 intramedullary tumors: pediatric intramedullary tumors are relatively common, and intramedullary tumors cause pain far less common than extramedullary tumors.
(2) Sensory disturbance: manifested as sensory loss or paresthesia (numbness or ant feeling) below the plane of the damaged spinal cord, the incidence rate is lower than that of the adult group, mainly because the child's ability to express the sensory disturbance is poor, and the examination does not cooperate. Therefore, it is more difficult to judge.
(3) dyskinesia: weak limbs in children with spinal canal tumors are more prominent, cervical spinal cord lesions can have limb muscle weakness. The thoracolumbar lesions were characterized by weakness of the lower extremities, increased muscle tone and positive pathological reflexes; the lumbosacral segment showed signs of cauda equina injury, low muscle tone and tendon reflex; some children could not support weight due to lower extremity muscle strength and gait was not Stable, may be accompanied by deformation of the spine bones and muscle atrophy.
(4) rectal and bladder dysfunction: manifested as sphincter dysfunction, the incidence is higher than adults, may have anal relaxation, incontinence when crying.
(5) combined with abnormal skin in the spine or midline: there may be spinal deformity (protrusion or lateral deformity), mostly the result of long-term chronic compression of tumors in the embryonic residual tissue. The spinal canal may have developmental closure disorder and manifest as lamina For example, recessive spine fissure, etc.; the back or lumbosacral skin may have abnormal distribution of fur sinus or local hair.
(6) History of meningitis: About 10% of children have a history of unexplained meningitis, most of which are recurrent episodes of meningitis. It is difficult to control various antibiotics. It is common in spinal canal-like or epithelioid cysts, with fur sinus and Intervertebral canal communication is therefore prone to infection.
2. Clinical manifestations of different parts of the tumor
(1) vertebral tumors: children originated from vertebral bone tumors are more common than adults, the most common are aneurysmal bone cysts and bone eosinophilic granuloma, chordoma and benign bone tumors are also more common, aneurysms The bone cyst can cause the vertebral body to explode bone destruction. The clinical manifestations are mainly pain and spinal cord compression. Cervical spondylopathy can be characterized by characteristic torticollis, lumbar vertebrae lesions with radiculopathy, CT can be seen clearly inside the vertebrae. Multi-atrial, expansive soft tissue lesions, bone destruction and bone formation, treatment can be treated with resection of the vertebral body and vertebral body fusion, radiation therapy is not certain, bone eosinophilic granuloma is common in the cervical spine, slightly Trauma can cause pain in the neck. Although cervical dislocation is rare in children, severe pain, torticollis and radiculopathy are more common in children. The treatment can be surgically removed, but some vertebral bodies should be preserved. The structure is fixed internally to avoid instability of the vertebral body. Radiotherapy and chemotherapy have certain effects. It can be used for children with multiple or multiple violations. The chordoma is more common in the Shanwei area. Cervical segment, vertebral bone destruction, the corresponding segment of the spinal cord compression symptoms, invasive growth of the upper cervical segment and slope chordoma can lead to posterior group of neurological damage symptoms, clinical manifestations similar to posterior fossa tumor, due to tumor Has a tendency to malignant changes, so early diagnosis should be diagnosed early, the value of radiotherapy and chemotherapy is limited, and surgery should be completely removed.
(2) extramedullary tumors: extramedullary tumors in children are mostly located in the appendix, often combined with spinal canal regurgitation, local skin may have significant signs, such as: subcutaneous lipoma, hemangioma, abnormal hair distribution and fur sinus, as shown 1, common tumors are: intraspinal lipoma, dermoid cyst, epidermoid cyst, intestinal cyst and teratoma, are caused by congenital dysplasia, can produce tethered cord syndrome, children Tail area lipoma invasion is extensive, can be located inside or outside the dura mater or wrapped in the cauda equina, the tumor and the pia mater are tightly attached, and there is a fibrous septum penetrating into the intramedullary. Symptoms of radiculopathy are rare, mainly with limb numbness and rectal bladder sphincter. Dysfunction-based, imaging has a characteristic manifestation of adipose tissue, difficult to complete surgical resection, dermoid cysts and epidermoid cysts in addition to the general performance of intraspinal space occupying, due to leakage of cyst content caused by repeated stimulation Meningitis of the attack, extramedullary tumors in adults, neurofibromas and meningioma are rare in childhood, mostly in children with neurofibromatosis, neurofibroma Originated from the sensory nerve roots, tumor growth can lead to the expansion of the intervertebral foramen, resulting in obvious symptoms of radiculopathy and spinal cord compression. Intrathecal implantation of intracranial tumors can also be manifested as extramedullary tumors in children, common medullary Blastoma, malignant ependymoma or malignant choroid plexus papilloma.
(3) intramedullary tumors: primary tumors in the spinal cord account for about 60% of all central nervous system tumors in childhood, of which astrocytoma accounts for 65%, ependymoma accounts for 28%, and the rest are rare tumors. Such as cavernous hemangioma, lipoma epithelioid cyst and hemangioblastoma, etc. Children's intramedullary tumors are mostly located in the cervical and thoracic segments of the spinal ganglia. Tumors often invade multiple spinal segments. Pain is the most common first symptom. The nature is burning pain or tingling, but it is not as strong as radicular pain. Later, exercise, sensory dysfunction and sphincter dysfunction may occur. The torticollis and scoliosis are also common.
The vast majority of intramedullary astrocytomas are low-grade gliomas, about 10% to 15% are malignant, and children with intramedullary astrocytoma are slightly different from adult tumors. Most of the pathological types are hairy cell types, and children. Cerebellar astrocytoma has similar histological features (large cystic changes with small tumor nodules), and children can be seen in the medullary latch to the spinal cone. Any spinal segment of the spinal cord is hollow, accounting for all spinal cord cells. 60% of the tumor, so it is important to determine the location of the substantial tumor nodules in the capsule. When the tumor is a metamorphic star or glioblastoma, the cyst is in the tumor, the wall is the tumor, and the spinal cord There is no obvious boundary, and the quality is tough, the surgical resection is difficult, and the use of motor evoked potentials and somatosensory evoked potentials to monitor the spinal cord function during surgery can help to completely remove the tumor and reduce the damage of normal spinal cord tissue.
Ependymoma cystic changes and calcification are rare. Tumors occurring in the cauda equina and terminal filaments are extramedullary tumors. Tumors can be spread along the cerebrospinal axis and form a soft meningeal implant. Therefore, conventional radiotherapy should be performed after partial resection of the operation. Can do a total tumor resection without radiotherapy.
Intramedullary hemangioblastoma is rare in children, and most of them are a clinical manifestation of Hippel-Lindau disease. Tumors are often confined to several spinal segments, which may have cystic changes, and tumors are prone to spontaneous bleeding.
Examine
Pediatric intraspinal tumor examination
1. Blood examination: When the infection is present, the peripheral blood leukocyte count and neutrophils can be significantly increased.
2. Lumbar puncture: post-lumbar puncture and dynamic test, often have different degrees of spinal subarachnoid obstruction, the majority of cerebrospinal fluid protein content increases, the more complete obstruction, the lower the obstruction site, the higher the protein content, nerve fiber The protein quantification of tumor and meningioma is higher than other tumors. The number of cells in cerebrospinal fluid is generally normal. The number of white blood cells in epithelioid cysts or dermoid cysts can be increased. If the puncture just penetrates into the lumbosacral tumor, there is no Cerebrospinal fluid outflow, skin or epithelioid cysts can be pulled out of the "tofu residue" sample.
3. Spinal X-ray film: due to the long-term pressure of congenital tumors, the pedicle is flattened and the spinal canal is widened, and the posterior margin of the vertebral body is depressed. The children with embryogenic tissue in the spinal canal are combined. Recessive spina bifida or spinal canal regurgitation, dumbbell-like neurofibroma mostly with intervertebral foramen enlargement, epidural tumor often has vertebral or pedicle bone destruction.
4. CT examination: vertebral tumors (such as aneurysmal bone cysts, eosinophilic granuloma, chordoma, giant cell tumor of bone, etc.) often see vertebral collapse, extensive bone destruction, low-density lesions, surrounding High-density osteogenic reaction or calcification can be seen; there are many soft tissue masses with vertebral body swelling and unclear borders. When developing into the spinal canal, the compression of the spinal cord can be seen. Intramedullary tumors (endothelium, astrocytes) Tumor, hemangioblastoma, etc.) more common thickening of the spinal cord, swelling, accompanied by narrowing of the subarachnoid space or epidural space, uniform tumor density, mostly low or equal density, a few high Density, tumor and normal spinal cord are unclear, can be enhanced or not enhanced, extramedullary subdural tumors (neurofibroma, meningioma, lipoma and intestinal cyst) can be different for different types of tumors, nerves Fibroids are usually equal or slightly higher density, with cystic changes and calcification, moderate uniform enhancement, can cause expansion of the spinal canal or intervertebral foramen due to extraspinal growth of the tumor, and more common "dumbbell" type lump connected inside and outside the spinal canal. Shadow; meningioma mostly high density, obvious uniform enhancement; fat The tumors are mostly lobulated low-density masses, which are not strengthened; the intraductal cysts in the spinal canal are mostly located in the ventral side of the cervical thoracic spinal cord, and the boundary rules are clear, showing cystic signals, no enhancement or only slight enhancement of the capsule; A common feature of the external subdural tumor is that the density of the spinal cord is normal, and the change in compression is dominant. It can be seen that the subarachnoid is strongly enlarged on the tumor and narrowed or disappeared on the tumor plane. The dura mater The external tumor sees a sharp soft tissue mass in the inner edge of the spinal canal. The dural sac is compressed, the spinal cord is shallowly curved, and the adjacent bone can be damaged.
5. MRI examination: MRI sagittal imaging of the spinal cord can be independent of the physiological curvature of the spine, fully and continuously showing the relationship between the total length of the spinal cord and the anterior and posterior margin of the spinal canal, to better determine the anatomical boundary of the lesion; the coronal position can observe the spinal cord The shape of the nerve roots and spinal cord on both sides to identify the intramedullary extramedullary lesions and their extent; and MRI has better signal characteristics than the CT in the lesions of the spinal cord, which is the preferred examination for spinal lesions.
Diagnosis
Diagnosis and diagnosis of intraspinal tumor in children
diagnosis
Diagnosis is more difficult than adult spinal canal tumors, such as children with unexplained crying, weak lower limbs or incontinence, etc., should have thought of the possibility of spinal cord tumors, such as recurrent episodes of meningitis with unexplained causes, should be carefully Check the lumbosacral segment for abnormal hair distribution or fur sinus. For suspicious cases, you can first do a positive X-ray examination of the spine. If there is a change, you can do a CT or MRI examination to confirm the diagnosis.
Differential diagnosis
1. Spinal tuberculosis: It has been very rare recently. Generally, there are primary tuberculosis lesions in the lungs. The spine has localized tenderness. In severe cases, there may be posterior kyphosis, and the erythrocyte sedimentation rate is increased. X-ray plain film can be seen in vertebral bone destruction. Deformation, abscess can be seen in the paravertebral.
2. Transverse myelitis: a short history, often with fever at the beginning, limb muscle strength is progressively weakened, short-term can be full sputum, lumbar puncture without obstruction, spine plain film without vertebral bone abnormalities.
3. Poliomyelitis: seasonal onset, more common in late summer and early autumn, with children aged 2 to 4 years old, with a history of infection and fever, more than one limb or asymmetrical lower limbs, muscle atrophy is more obvious, cerebrospinal fluid lymph The amount of cells and protein was increased, and there was no spinal canal obstruction in the lumbar puncture test.
