Tumours involving the neural foramina in children: beyond neuroblastoma

AIM: To characterise tumours that involve the neural foramina in children, including prevalence, demographics, and imaging features. MATERIAL AND METHODS: This retrospective single-centre study comprised 36 boys and 34 girls who presented with spinal or paraspinal lesions involving the neural foramina. Two certified radiologists reviewed the imaging features, including the level of spinal involvement, the number of involved foramina, foraminal widening, tumour epicentre, and cord compression. Medical charts were reviewed for patients' demographics and tumour pathology. Tumours were classified as benign or malignant, and neuroblastomas were further classified as low or intermediate risk versus high risk. RESULTS: Thirty-three (47%) of the patients had neuroblastic tumours. Fourteen (20%) of the patients had sarcomas (mainly Ewing sarcoma). Other less common aetiologies included neurofibromas, germ cell tumours, Langerhans cell histiocytosis and haemangiomas. Neuroblastic tumours were particularly common in the thoraco-lumbar region, and considerably less prevalent in the sacral and cervical regions. Additional features, such as foraminal widening, the number of foramina involved, and cord compression, did not help discriminate between neuroblastic and non-neuroblastic tumours. Most tumours (80%) were malignant. Most benign tumours (>50%) were associated with a genetic predisposition syndrome. CONCLUSION: In evaluating neoplasms that involve the neural foramina in children, neuroblastic tumours are most common. Nevertheless, other aetiologies should be considered, mainly sarcomas. Most lesions in children are malignant. When encountering a benign mass, genetic counselling should be considered.