they are firm encapsulated benign tumors and total surgical removal can be achieved in most of the cases with an excellent outcome .
the study included 21 patients in the pediatric age group ( < 18 years ) of spinal schwannomas who underwent surgery over 10 years from january 1998 to april 2008 in the department of neurosurgery , national institute of mental health and neurosciences , bangalore .
the demographic profile , clinical features , radiological findings , operative procedures , postoperative complications , and outcome were noted and analyzed .
there were a total of 21 patients with an age range of 6 - 18 years with a median age of 16 years .
the duration of symptoms ranged from 1 month to 36 months with average duration of 5 months .
six patients had bladder disturbances ( 29% ) and six patients had associated neurofibromatosis . among these , five had neurofibromatosis type i with multiple caf - au - lait spots and multiple subcutaneous swellings , and one had neurofibromatosis type ii with bilateral vestibular schwannomas .
this patient underwent emergency decompression of the tumor and was put on ventilator . gradually the patient was weaned off from the ventilator support and made significant improvement .
the predominant location was the cervical region in 10 cases ( 47% ) , followed by dorsal in 8 cases ( 38% ) . in three patients ,
four of the 21 patients had dumbbell schwannomas . among the 21 patients , 18 underwent laminectomy , 3 underwent laminotomy and microsurgical excision of the tumor .
twenty patients underwent gross total excision and one underwent partial excision in view of tight adherence to multiple nerve roots in cervical region .
the follow - up period ranged from 4 months to 56 months with average follow - up period of 38 months .
motor deficits improved by at least one grade in 6 patients and by 2 grades in 10 patients .
of the six patients who had bladder symptoms , four patients made improvement in urinary symptoms and two patients were on intermittent self - catheterization .
x - rays of the spine was performed at follow - up and showed no signs of instability in any of the patients .
follow - up mri at last follow - up revealed no recurrence in any of the patients .
there were a total of 21 patients with an age range of 6 - 18 years with a median age of 16 years .
the duration of symptoms ranged from 1 month to 36 months with average duration of 5 months .
six patients had bladder disturbances ( 29% ) and six patients had associated neurofibromatosis . among these , five had neurofibromatosis type i with multiple caf - au - lait spots and multiple subcutaneous swellings , and one had neurofibromatosis type ii with bilateral vestibular schwannomas .
this patient underwent emergency decompression of the tumor and was put on ventilator . gradually the patient was weaned off from the ventilator support and made significant improvement .
the predominant location was the cervical region in 10 cases ( 47% ) , followed by dorsal in 8 cases ( 38% ) . in three patients ,
among the 21 patients , 18 underwent laminectomy , 3 underwent laminotomy and microsurgical excision of the tumor .
twenty patients underwent gross total excision and one underwent partial excision in view of tight adherence to multiple nerve roots in cervical region .
the follow - up period ranged from 4 months to 56 months with average follow - up period of 38 months .
motor deficits improved by at least one grade in 6 patients and by 2 grades in 10 patients .
of the six patients who had bladder symptoms , four patients made improvement in urinary symptoms and two patients were on intermittent self - catheterization .
x - rays of the spine was performed at follow - up and showed no signs of instability in any of the patients .
follow - up mri at last follow - up revealed no recurrence in any of the patients .
spinal cord tumors are a relatively rare diagnosis and account for 1% to 10% of all pediatric central nervous system tumors .
this is in contrast with adults where they constitute about 25% of primary intradural tumors .
however , some studies indicate a higher incidence of spinal schwannomas in males , as reported by hori et al .
( 57% ) , and this percentage corresponds to our study in which 67% of schwannomas appeared in the female population . in our study , the majority of the patients presented with progressive compressive myelopathy ( 86% ) .
the frequency of motor involvement and localized pain was much higher in our study compared with the available literature where it has ranged from 40% to 60% .
the autonomic ( bowel and bladder ) involvement in our study was 29% compared to 10 - -20% in the literature .
( five had nf i and one had nf ii . ) the most common spinal tumors in nf i are neurofibromas .
paraspinal neurofibromas including dumbbell - shaped tumors are commonly found in asymptomatic patients , especially at younger age groups .
the most common location was the cervical region ( 47% ) followed by the dorsal region in 38% of the cases [ figure 1 ] .
this differs from the available literature in which the majority of the tumors are located in the cervical and lumbar regions .
according to the available literature 70 - -80% of spinal schwannomas are intradural in location and those extending through the dural aperture as the dumbbell mass involving both intradural as well as extradural space account for another 15% .
intramedullary schwannomas are extremely rare . in our study , 17 patients had intradural schwannomas ( 80% ) and 4 patients ( 20% ) had dumbbell schwannomas .
preoperative magnetic resonance imaging cervical spine ( post contrast- sagittal ) showing well - defined contrast enhancing intradural extradural lesion all our patients underwent surgery and excision of the tumor ( gte in 20 and ste in 1 ) ; [ figures 2 and 3 ] the outcome is comparable to the available literature and correlates with the preoperative neurological status of the patient .
preoperative magnetic resonance imaging ( mri ) cervical spine ( post contrast - axial ) showing well - defined contrast enhancing intradural extradural lesion with the cord pushed to the left ( arrow ) postoperative magnetic resonance imaging ( mri ) cervical spine ( t2-weighted ) showing complete excision
spinal cord tumors are a relatively rare diagnosis and account for 1% to 10% of all pediatric central nervous system tumors .
this is in contrast with adults where they constitute about 25% of primary intradural tumors .
however , some studies indicate a higher incidence of spinal schwannomas in males , as reported by hori et al .
( 57% ) , and this percentage corresponds to our study in which 67% of schwannomas appeared in the female population . in our study , the majority of the patients presented with progressive compressive myelopathy ( 86% ) .
the frequency of motor involvement and localized pain was much higher in our study compared with the available literature where it has ranged from 40% to 60% .
the autonomic ( bowel and bladder ) involvement in our study was 29% compared to 10 - -20% in the literature .
( five had nf i and one had nf ii . ) the most common spinal tumors in nf i are neurofibromas .
paraspinal neurofibromas including dumbbell - shaped tumors are commonly found in asymptomatic patients , especially at younger age groups .
the most common location was the cervical region ( 47% ) followed by the dorsal region in 38% of the cases [ figure 1 ] .
this differs from the available literature in which the majority of the tumors are located in the cervical and lumbar regions .
according to the available literature 70 - -80% of spinal schwannomas are intradural in location and those extending through the dural aperture as the dumbbell mass involving both intradural as well as extradural space account for another 15% .
intramedullary schwannomas are extremely rare . in our study , 17 patients had intradural schwannomas ( 80% ) and 4 patients ( 20% ) had dumbbell schwannomas .
preoperative magnetic resonance imaging cervical spine ( post contrast- sagittal ) showing well - defined contrast enhancing intradural extradural lesion
in our study , the majority of the patients presented with progressive compressive myelopathy ( 86% ) .
the frequency of motor involvement and localized pain was much higher in our study compared with the available literature where it has ranged from 40% to 60% .
the autonomic ( bowel and bladder ) involvement in our study was 29% compared to 10 - -20% in the literature .
( five had nf i and one had nf ii . ) the most common spinal tumors in nf i are neurofibromas .
paraspinal neurofibromas including dumbbell - shaped tumors are commonly found in asymptomatic patients , especially at younger age groups .
the most common location was the cervical region ( 47% ) followed by the dorsal region in 38% of the cases [ figure 1 ] .
this differs from the available literature in which the majority of the tumors are located in the cervical and lumbar regions . according to the available literature 70 - -80% of spinal schwannomas
are intradural in location and those extending through the dural aperture as the dumbbell mass involving both intradural as well as extradural space account for another 15% .
intramedullary schwannomas are extremely rare . in our study , 17 patients had intradural schwannomas ( 80% ) and 4 patients ( 20% ) had dumbbell schwannomas .
preoperative magnetic resonance imaging cervical spine ( post contrast- sagittal ) showing well - defined contrast enhancing intradural extradural lesion
all our patients underwent surgery and excision of the tumor ( gte in 20 and ste in 1 ) ; [ figures 2 and 3 ] the outcome is comparable to the available literature and correlates with the preoperative neurological status of the patient .
preoperative magnetic resonance imaging ( mri ) cervical spine ( post contrast - axial ) showing well - defined contrast enhancing intradural extradural lesion with the cord pushed to the left ( arrow ) postoperative magnetic resonance imaging ( mri ) cervical spine ( t2-weighted ) showing complete excision
 objective : the objective was to analyze the demography , clinical presentation , and management of spinal intradural schwannomas in pediatric population.materials and methods : this retrospective study includes 21 pediatric patients ( under 18 years of age ) who underwent surgery for spinal intradural schwannomas from january 1998 to april 2008 . 
 the medical records were reviewed retrospectively and the information regarding clinical presentation , tumor location , operative findings , and postoperative status and functional outcome were analyzed.results:a total of 21 patients ( 14 females and 7 males ) were operated for spinal schwannomas . 
 six patients had associated neurofibromatosis ( five were nf i and one was nf ii ) at presentation . 
 the most common presenting symptom was progressive myelopathy ( 86% ) . 
 the tumor location was either cervical or dorsal in 18 cases . 
 all patients underwent surgery . 
 gross total excision was achieved in 20 cases . 
 the median follow - up was 38 months . 
 all the patients had neurological improvement in both power and bladder symptoms.conclusion:pediatric spinal neurofibromas / schwannomas are an uncommon but completely treatable group of tumors . 
 complete surgical excision gives excellent outcome . 
Introduction
Materials and Methods
Results
Demographic features
Clinical features
Radiology
Management and follow-up
Discussion
Demography
Clinico-radiological features
Management strategies
Conclusion