[size=20px]A 15-month old presents with abdominal distension, pain and lower extremity weakness. On physical examination she has a large palpable abdominal mass that extends into the pelvis. She has decreased tone of the right lower extremity and refuses to bear weight. An abdominal/pelvic computerized tomography scan reveals a large pelvic mass that crosses the midline and extends into the right L5 neural foramina with spinal cord compression. What is the most critical step in management of neuroblastoma with spinal cord compression?

 

A immediate pelvic primary tumor resection to relieve symptoms

 

B immediate laminectomy and cord decompression

 

C initiation of chemotherapy with laminectomy reserved for failure to improve[/size]

C

C

correct

 

Neuroblastoma (NB) can often extend into the intervertebral foramina. Extraction of tumor from this location is controversial and can be associated with significant neurological complications. Cord compression can occur from NB invasion and is an oncologic emergency requiring rapid intervention. Retrospective analyses show similar neurologic outcomes for patients treated with chemotherapy versus laminectomy. Given the long term morbidity of laminectomy in young patients neurosurgery should likely be reserved for patients with rapid neurologic deterioration or in patients that develop worsening symptoms while receiving chemotherapy. Spinal deformity is a considerable risk in NB patients undergoing operation for epidural disease. Such operations are undertaken in cases of critical neurological symptoms or in a small subset of low risk patients who may be spared chemotherapy with a curative operation.