Unilateral hemilaminectomy for pediatric intradural spinal tumors: a consecutive case series

Purpose: To describe the perioperative, oncologic, and structural outcomes of unilateral hemilaminectomy for pediatric intradural spinal tumors. Methods: We retrospectively reviewed all children aged ≤ 16 years who underwent unilateral hemilaminectomy for an intradural spinal tumor at a single tertiary center between 2018 and 2023. Clinical records, operative data, early postoperative contrast-enhanced MRI, and subsequent surveillance imaging were evaluated. Primary outcomes were 30-day complications and clinically detected postoperative deformity or instability requiring further evaluation or treatment. Results: Among 246 spinal tumor operations across all age groups, 11 involved children; six extradural tumors were excluded, and all five pediatric intradural tumors underwent unilateral hemilaminectomy. Four patients were aged 13–16 years. Early postoperative MRI demonstrated gross-total resection in three patients, near-total resection in one, and subtotal resection in one. In the latter patient, a greater than 80% reduction in motor-evoked potential amplitude prompted termination of the index procedure without tumor resection. An unplanned second operation was performed 7 days later, but similar monitoring deterioration limited resection to subtotal removal. The child experienced transient quadriparesis after both procedures; both episodes resolved before discharge. Stereotactic radiotherapy was subsequently administered. During a median follow-up of 26 months (range, 18–84 months), no tumor-related reoperation or clinically detected deformity or instability requiring bracing, referral, or fusion was documented. Conclusion: Unilateral hemilaminectomy provided surgical access for pediatric intradural tumors while preserving the contralateral posterior elements. However, the small, predominantly adolescent cohort, absence of systematic standing radiographs, and limited follow-up preclude conclusions regarding subtle or late deformity or comparative superiority.