Intraspinal neoplasms in infants and children; clinical analysis of 61 cases, (4)

Although the number of invasive diagnosic procedures for intracranial lesions has been decreasing after computerized tomography (CT scan) appeared, the advantage of the CT scan as a definite diagnostic procedure for intraspinal lesions is still debatable. The purpose of this paper is to discuss the advantages of computerized axial tomography in the diagnosis of intraspinal tumors of children by comparing the findings of spine X-ray, myelography and operations. Twenty-four children with intraspinal neoplasms were analyzed. In extradural tumors, the CT scan clearly disclosed the tumor extension to the paravertebral area in the cases of ganglioneuroma and neuroblastoma. The exact locations of a calcified mass in the spinal canal and bone destruction were seen in malignant lymphoma. In intradural-extramedullary tumors, intra- and extraspinal tumor involvement with an enlarged neural foramen was demonstrated by the CT scan in the cases of dumbbell-type malignant neurofibroma and schwannoma. Also in such tumors as lipoma and teratoma associated with congenital malformations, the CT scan showed more clearly the anatomical relations of these structures in the axial view. In intramedullary tumors, however, not much information except the existence of a cystic cavity in connection with the tumor was obtained by the CT scan. In all lesions, the metrizamide CT scan was extremely useful in identifying the location, shift, and expansion of the spinal cord. In conclusion, we emphasize the advantages of the CT scan in the diagnosis of intraspinal neoplasms, especially those located in intradural extramedullary or extradural space, in children who have tumors of a type different from those of adults. (author)