Clinical features and surgical outcomes of pediatric long-level intramedullary spinal cord tumors: a single-institution series of 42 cases.

Pediatric long-level intramedullary spinal cord tumor (PLIMSCT) is one of the more complicated neurosurgical diseases, and there is very little research on PLIMSCT at present. This study aims to analyze the relevant clinical features and surgical outcomes of PLIMSCT through comparison. This study retrospectively analyzed pediatric intramedullary spinal cord tumor patients who underwent surgical treatment in our hospital from January 2015 to June 2024. The relevant data of patients were collected to conduct a comparison of the differences in clinical characteristics among various levels, and to analyze the potential factors that might influence the surgical outcomes. A total of 96 pediatric intramedullary spinal cord tumor patients were included, among which there were 42 cases in the long-level group. All patients underwent surgical treatment. The most common initial symptom in all parents was motor deficit (n = 51, 53.1%). In the long-level group, the symptom duration was mainly ≤ 1 year (n = 30; 66.7%), while in the short-level group, it was mostly > 3 years (n = 25; 83.3%). The most frequently involved level of tumors in both the long-level and short-level groups was the thoracic level (n = 14, 32.6% versus n = 29, 67.4%). Among all patients, 71 cases underwent gross total resection (GTR), including 32 cases (45.1%) in the long-level group and 39 cases (54.9%) in the short-level group. At admission, most patients had mild neurological deficits (MMS II). Comparison showed that there was no statistical difference in preoperative MMS between the two groups (p = 0.590), but it was different in postoperative MMS (p = 0.003). The overall survival rate was not related to the length of the tumor but was related to the WHO grade of the tumor. For PLIMSCT patients, logistic regression indicated that initial symptoms independently affected short-term neurological function, while WHO grade and postoperative MMS were related to long-term neurological function. In PLIMSCT patients, low-grade astrocytoma is the prevalent pathological type. The initial state of patients independently affects short-term neurological function. Surgical resection extent has no impact on postoperative neurological function, and tumor length doesn't influence long-term neurological decline. Long-term neurological function is mainly determined by the characteristics of the tumor and the postoperative neurological status.