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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 epidemiology, clinical features, histopathology, and treatment outcomes of pediatric PSCTs managed at three major tertiary care centers in Pakistan.

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. Demographics, presenting symptoms, MRI features, surgical details, histopathology, and outcomes were extracted using REDCap and analyzed using R version 4.2.0.

Among 47 pediatric patients, 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 presentation. Ependymomas were the most frequent histopathology (36.2%), followed by gliomas (25.5%), including four high-grade gliomas. Of 39 patients who underwent treatment, GTR was achieved in 53.8%, while STR was performed in 30.8%. Surgical complications occurred in six patients, and treatment-related complications occurred in three patients. All patients with high-grade gliomas died during treatment.

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.