Abstract Background Primary spinal cord tumors (PSCTs) are rare in children, accounting for 2–4% of pediatric central nervous system tumors, with limited data available from low- and middle-income countries (LMICs). Variability in clinical presentation, histopathological patterns, and treatment practices in resource-constrained settings further challenges early diagnosis and optimal management. This study describes the demographics, histopathology, and treatment outcomes of pediatric PSCTs managed at three major tertiary care centers in Pakistan. Methods We conducted a retrospective, multicenter review of all children and adolescents diagnosed with PSCTs between January 2010 and December 2024 at three tertiary care cancer hospitals Aga Khan University Hospital Karachi (AKUH), Indus Hospital and Health Network Karachi (IHHN), and Shaukat Khanum Memorial Cancer Hospital Lahore (SKMCH). Demographics, presenting symptoms, MRI features, surgical details, histopathology, and outcomes were extracted using REDCap and analyzed using R version 4.2.0. Results Total number of patients were 47. Most patients (66.0%) were managed at AKUH, followed by IHHN (27.7%) and SKMCH (6.4%) The median age at diagnosis was 14 years (IQR 9–16), with a mean symptom duration of 7.5 ± 9.1 months. Most tumors were intradural (97.8%), predominantly intramedullary (63.6%). Limb weakness (80.9%) and back pain (66.0%) were the most common symptoms of presenting. Majority of the tumors were in cervical 31.9% and thoracic 29.7% region. Ependymomas were the most frequent histopathology (36.2%), followed by gliomas (25.5%), with 17% low-grade gliomas and 8.5% high-grade gliomas. Remaining cohort had neurofibroma 10.6%, schwannoma 8.5% and meningioma 4.3%. Of 39 patients who underwent treatment, Gross total resection was achieved in 53.8%, while subtotal resection was done in 30.8%. Surgical complications occurred in six patients, and treatment-related complications in three patients. All patients with high-grade gliomas died during treatment. Conclusion This multicenter study provides the most comprehensive pediatric PSCT dataset from Pakistan, highlighting delayed presentations, predominance of intramedullary tumors, and significant histopathological variability. Outcomes remain limited for high-grade tumors, underscoring the need for earlier diagnosis, standardized multidisciplinary care, and strengthened neurosurgical capacity in LMICs.
Bashir et al. (Tue,) studied this question.