CMU Children’s Hospital, Division of Pediatric Neurosurgery

Director and Physician Yu-Kai Cheng

Guo (anonym) has suffered from cervical pain for a long time but has neglected the pain since there were no symptoms. His family only noticed and puzzled when Guo could not put his arms into the sleeves. The family considered it a habit developed by Guo. Two years ago, Guo started to have difficulties raising his left arm and he was on medication and rehabilitation for more than half year. His conditions were unstable and it was when he experienced weakness of upper extremities, increased extremity tone, and slow walking, Guo then transferred to the CMU Children’s Hospital, Division of Pediatric Neurosurgery and took the magnetic resonance imaging (MRI). He examination revealed that there was a giant tumor spreading from brain stem to the seventh cervical vertebra. Fortunately after 17 hours of difficult tumor resection surgery and chemotherapy, there has not been recurrence after one year and Guo could take care of himself.

CMU Children’s Hospital, Division of Pediatric Neurosurgery Director and Physician Yu-Kai Cheng explained that Guo’s severe spinal tumor constricts the normal nerves and affected extremity strength and balance. After explaining the indications and risks associated with the surgery treatment to the patient and family, the patient was administered to the hospital for surgery in May, 2020. Since the tumor spread deep into the brain stem and spinal cord, any mishap could lead to paralysis or difficulty in spontaneous breathing, and the patient could be bedridden for a long time. Fortunately the CMU Children’s Hospital owns a comprehensive professional surgical technology and a intraoperative neuromonitoring team. In the extended 17 surgery hours, the medical team try to remove all tumor and avoid areas that could cause permanent nerve injury. Guo could breathe normally after the surgery and did not have to accept tracheotomy or use a respirator. His strength of extremities also gradually recovered while the tumor pathology report indicated pilocytic astrocytoma. The Division of Pediatric Hematology and Oncology assessed and applied 6 sessions of chemotherapy to eradicate the residual tumor. Gup has recovered well without any recurrence after one year. He could take care of himself and has returned to school now.

Physician Yu-Kai Cheng expressed that pediatric spinal tumor is a very rare condition and only accounts for 0.5~1% of all nerve tumors. Among which, 90% is glioma and mostly to metastatic. Such type of tumor will mostly have early syndromes such as cervical or lower back pain. The syndromes are recurrent without particularity, which are relatively negligible and resulting in delayed diagnosis. As tumor invasion spreads in areas eventually, the patient will experience weak muscles, progressive scoliosis, gait instability, stiff muscles and convulsion. It is then the patient will discover anomalies and schedule for further examination. Such type of tumor usually grows from the nerve system and hence there will be unclear boundary between the tumor and normal nerves. If a neurosurgeon relies on naked eyes to determine the boundary during surgery, he/she will highly likely damage the normal nerves and cause patient nerve damage in the patient. Moreover, when Guo was diagnosed, the tumor already spread from his brain stem to the seventh cervical vertebra, which area governs the heat beat, breathing, blood pressure, swallowing, and extremity strength, as well as other vital functions. Therefore, this surgery is considerably difficult and must require professional neurosurgeons and the comprehensive intraoperative neuromonitoring team for treatment. The post-operative chemotherapy and radiation therapy also require the participation by experienced physicians for a complete treatment process.

Physician Yu-Kai Cheng would like to remind parents that if the children do not have medical history of trauma but suffer from abnormally severe cervical or back pain, weak extremities and have been treated with general medication, sports, rehabilitation and other treatment for more than 3 months or half year but without any effect, the parents should take the children to seek for diagnosis and treatment from the division of rehabilitation from major hospitals and pediatric internal and neurosurgery as soon as possible, in order to arrange special examination for early discovery and early treatment.