Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>To improve results of surgical treatment of ventral and ventrolateral tumors of the spinal cord, the authors analyzed surgical approaches, defined the indications for various approaches, and assessed the clinical results.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1993 and 2004 the authors treated 360 patients: 43 of them had dorsal, 177 dorsolateral, 33 ventral, and 107 had ventrolateral intradural extramedullary tumors. Among 140 patients with intradural extramedullary ventral and ventrolateral tumors, neuromas were seen in 56 and meningiomas in 84. Of the 140 patients studied, tumors were removed totally in 102 (74%), subtotally in 30 (21%), and partially in eight (5%). After ventrolateral and dorsolateral approaches were introduced in 1996, tumors in ventral or ventrolateral locations have been removed totally or subtotally. In the group of patients with meningiomas, 41 of the lesions were the meningothelial type, 22 were transitional, 12 fibroblastic, four psammomatous, three were angiomatous, one was atypical, and one was malignant. Tumors in the neuroma group were schwannomas in 45 patients and neurofibromas in 11. Postoperatively, recovery was observed in 70 patients (50%), improvement in 53 (38%), no change in 10 (7%), and deterioration in seven (5%). At follow-up evaluation recovery was noted in 76 patients, improvement in 58, no change in four, and in two patients the neurological symptoms were worse than before the operation.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Surgical routes to extramedullary tumors should be chosen based on the location of the tumor, its spread, and the region in which it is localized.</jats:p></jats:sec>

Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience

“…Slin'ko and colleagues have demonstrated that the more proximal the location of a tumor and the more ventral the tumor was to the spinal cord, the worse the surgical outcome and greater the likelihood of having a postoperative neurological deficit. 18 Conversely, Ahn and colleagues 3 found no association between ventral tumor location and poor outcomes. Thus, the prognostic value of a ventral tumor location remains unclear.…”

“…Slin'ko and colleagues suggested that an extreme lateral or anterior approach was necessary for resection of ventrally located tumors. 18 However, Ahn and colleagues in a retrospective study of patients that underwent surgical resection of IDEM tumors via a posterior approach, reported no difficulties in removing ventrally located IDEM tumors. Furthermore, these authors suggest that extreme lateral or anterior approaches might not be necessary.…”

Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome

“…Spinal meningiomas account for 15%-46% of all primary spinal cord tumors. 1,31,36,44 They are less common than their cranial counterparts, accounting for less than 2% of all meningiomas of the central nervous system. 33 However, this proportion increases in patients with NF2.…”

Surgical Outcome in IDEM Tumors in Short Term Follow Up

“…According to the literature, 31% of the tumors are located ventral to the spinal cord and Slin'ko and Al-Qashqish claimed that an extreme lateral or an anterior approach was necessary for the removal of these tumors. [12,13] However, extreme lateral approaches require spinal fusion due to the removal of the lamina and the facet joint, and the anterior approaches are difficult to use due to the epidural venous bleeding, the limited field of view and the removal of several vertebral bodies.…”