Purpose <p> Pediatric intraspinal space-occupying lesions are rare but may cause substantial neurological morbidity when diagnosis or treatment is delayed. This study aimed to characterize the clinicopathological spectrum, anatomical distribution, operative management, and early neurological outcomes of pediatric intraspinal lesions treated at a single tertiary neurosurgical center.</p> Methods <p> We retrospectively reviewed 27 consecutive patients aged 14 years or younger who underwent surgery or image-guided biopsy for confirmed intraspinal space-occupying lesions between January 2018 and February 2025. Clinical presentation, magnetic resonance imaging findings, lesion compartment, operative strategy, histopathology, extent of resection, Modified McCormick Scale status, complications, recurrence or progression, and follow-up outcomes were analyzed descriptively.</p> Results <p> The cohort included 14 girls and 13 boys, with a mean age of 10.11 years. Limb weakness and pain were the most common presenting symptoms. Lesions were intramedullary in 10 patients, intradural extramedullary in 10, and extradural in seven. Neoplastic pathology was confirmed in 23 cases. Gross-total resection was achieved in 19 patients, subtotal resection in five, partial resection in one, and biopsy in two. Limited resection or biopsy was selected when diffuse infiltration, suspected systemic malignancy, or unacceptable neurological risk precluded aggressive excision. Early postoperative neurological improvement was observed in 20 patients, whereas recurrent or progressive disease occurred in five during follow-up.</p> Conclusion <p> Pediatric intraspinal lesions show marked biological, anatomical, and radiological heterogeneity. Careful clinical suspicion, contrast-enhanced MRI, individualized operative planning, and function-preserving resection remain central to management. Multicenter data collection is needed to refine prognostic assessment and treatment recommendations.</p>