Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

Abstract

Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

Correlations between preoperative clinical factors and treatment outcome of spinal meningiomas – A retrospective study of a series of 31 cases

“…[7] Some authors question the real benefit from the use of IONM during intradural extramedullary tumor resection, [10] while others point that it is a valuable tool that minimizes surgical morbidity, especially in cases with tumors located in the craniovertebral junction or in anterior or anterolateral position and even in cases with tumors adherent to the spinal cord without a clear cleavage plane. [5,11] We applied IONM in only one patient from the current series who harbored intramedullary meningioma. Nevertheless, we favor the use of IONM during resection of intradural extramedullary tumors because of its potential to guarantee safer surgery and better outcomes.…”

Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

“…Влияние излучения неодимового лазера на частоту рецидивов и продолженного роста опухолей I.A. Eliseenko et al Influence of neodymium laser radiation on the frequency of recurrence and continued growth of tumors На долю первичных опухолей спинного мозга приходится от 5 до 15 % всех спинно-мозговых новообразований у взрослых и до 15 % от общего числа опухолей центральной нервной системы [1][2][3]. Частота их встречаемости составляет примерно 5 случаев на 1 млн для женщин и 3 случая на 1 млн для мужчин или 1,3 случая на 100 тыс.…”

“…Частота их встречаемости составляет примерно 5 случаев на 1 млн для женщин и 3 случая на 1 млн для мужчин или 1,3 случая на 100 тыс. населения в год [2][3][4]. Экстрамедуллярные опухоли (ЭМО) встречаются в 70-80 % случаев всех первичных опухолей спинного мозга и в 53-68 % от общего числа новообразований спинного мозга [2,5,6].…”

“…Несмотря на тотальное удаление этих опухолей, общая частота их рецидивов достаточно высока и составляет для неврином и менингиом 5 %, а для эпендимом -15 %. Более того, спинальные менингиомы рецидивируют, по данным разных авторов [3,8], с частотой от 4 до 31 %. При субтотальном удалении эпендимом частота продолженного роста варьирует около значения 43 % [2,10].…”

Long-Term Results of Nd: Yag Laser Surgery of Extramedullary Tumors: A Monocentric Retrospective Study of 412 Clinical Cases

“…примерно пять на миллион для женщин и три на миллион для мужчин [4] или 2,5 случая на 100 000 населения в год [2]. Экстрамедуллярные опухоли (ЭМО) диагностируются при лечении всех первичных опухолей и всех новообразований СМ, соответственно, в 70-80% и в 53-68,5% случаев [2; 5].…”