DISCUSSION
Approximately 10% of all pediatric central nervous neoplasms are located in the spinal cord, either intramedullary or extramedullary.3 It is estimated that 90% of intramedullary spinal cord masses are glial tumors.4These mainly include astrocytoma and ependymoma.5 All age groups be can be affected by these neoplasms; however, they occur more frequently in children less than 10 years of age. Overall, males and females are equally affected.5 The growth of the spinal cord tumors are slow, and symptoms are usually nonspecific, which is the reason why these tumors are frequently diagnosed at later stages.5 Patients typically have symptoms that tend to evolve over months to years. Most commonly, regional back pain is the complaint at first presentation.6
Fortunately, low-grade tumors comprise most spinal cord tumors. However, high-grade lesions account for only ten to fifteen percent of pediatric tumors, and they tend to occur in a slightly higher proportion in adults.6
Astrocytomas are slow-growing tumors. Typically, the interval between the onset of symptoms and the time of diagnosis is long and might take months or even years.6 Two thirds of the patients reported diffuse back pain as the initial manifestation. The pain they described was worse with lying down, causing nighttime symptoms.1,5
In France between 1971 and 1994, a review of 73 cases of spinal cord astrocytoma in pediatrics revealed that back pain was the most common presentation (89%), while 78% noticed to have gait abnormalities and 32% developed weakness in the upper limbs or sphincter disturbances. Fewer than 10% of the symptoms were headache and muscle weakness.3
Our patient did not initially present with back pain but rather with abdominal pain and with leaning forward while walking.
Regarding the modality of choice for diagnosis, MRI has excellent soft-tissue contrast. At the same time, it lacks ionizing radiation making it safe for children. There is still a debate about the treatment of many of these neoplasms. Still, the best option indicated by the current evidence is microsurgical resection, with adjunctive treatment being reserved in cases of recurrent or high-grade lesions.7