Surgical outcome of intradural extramedullary spinal cord tumors - Our experience at a tertiary health care center

Abstract

Introduction: To report the treatment results of 19 patients who underwent excision of intradural extramedullary (IDEM) spinal tumors.
 Materials & Methods: This is a retrospective study. Patients’ records were retrieved from the electronic database of Grande International Hospital. There were 19 IDEM spinal tumors excised over a period of 6 years between January 2013 and August 2019 by a single surgeon. There were 11 (57.9%) males and 8 (42.1%) females with an average age of 48.37±21.87 years (range, 5-79 years). The mean postoperative follow-up period was 12.87±14.88 months (range, 15 days - 60 months). The histopathological findings, locations of the tumors, and clinical results were analyzed. Neurological findings were evaluated using ASIA grading system and pain was evaluated using VAS score.
 Results: Histopathologically the tumors were: 8 meningioma (42.1%), 4 schwannoma (21.1%), 4 neurofibroma (21.1%), 1 dermoid cyst (5.3%), 1 lipoma (5.3%), and 1 myxopapillary ependymoma (5.3%). Tumor locations were: dorsal in 10 (52.6%), lumbar in 5 (26.3%), lumbosacral in 2 (10.5%), dorsolumbar in 1 (5.3%), and cervical in 1 (5.3%) patient. Neurologic status of 7 patients was normal and 12 had neurologic involvement with 3 patients having Cauda Equina Syndrome (CES) preoperatively. At the final follow-up, 3-grade, 2-grade and 1-grade improvement in ASIA score was observed in 1, 6 and 1 cases, respectively. There was no change in the ASIA grade in 1 case. All 3 cases of CES achieved full neural recovery. Preoperative VAS score was 9.21±1.08 and improved significantly to 0.74±1.62 after surgery. Neurological improvement was seen in 91.67% with complete recovery in 75% of the cases and not a single case deteriorated neurologically post-surgery.
 Conclusion: Most intradural-extramedullary spinal cord tumors are mostly benign and good clinical results can be obtained when adequately treated with surgery.

Evaluation of Intradural Extramedullary Spinal Tumors Management: Single Institutional Experience

“…We used IONM in 6 cases and it was very helpful, and all cases done with it had excellent improvement Generally, most series on IDEM had reported encouraging outcome (Table 5). There was excellent result ranging from 75% to 92.3% and overall improvement ranging from 82.6% to 100% (11,14,17,30,31) this was also quite similar to our results.…”

“…In the last years, surgical excision offered good result with the presence of operating microscope, microsurgical instrument, improved surgical techniques, intraoperative neuromonitoring and proper preparation by improved diagnostic tools as MRI and CT that helped for a clear understanding of anatomical structure (10,11) . The real clinical benefits of use of improved and minimally invasive techniques, and neuromonitoring are still debatable (12) .…”

Surgical Outcomes of Intradural Extramedullary Spinal Tumors Excision Using Intraoperative Neurophysiological Monitoring

“…In the present study pre-operative data among the studied patients revealed that 40% of patients had thoracic (dorsal) mass, followed by cervical, lumber, thoracolumbar and craniocervical mass in 25%, 20, 10% and 5% respectively with 65% had lesion extents in 1-2 vertebrae. In agreement with our study, Joshi et al (7) reported that the most common site of lesions on MRI in the study was dorsal in 10 (52.6%), lumbar in 5 (26.3%), lumbosacral in 2 (10.5%), dorsolumbar in 1(5.3%), and cervical in 1 (5.3%) patient. Furthermore Cofano et al (6) reported that about localization, the thoracic spine was involved in 109 cases (43.8%), while lumbar lesions occurred in 96 patients (38.5%) and cervical in 44 patients (17.7%).…”

“…However, IDEMs like en plaque meningioma, diffuse leptomeningeal glioneuronal tumor (DLGNT) and those tumors firmly adhered to the underlying spinal roots and rootlets and those arising from the ventral cord are almost impossible to grossly resect without causing neurological damages. In such tumors, residue is deliberately left to preserve the neurological function (7) . Laminectomies done for tumor excision may cause spinal instability and deformity if facets, its capsules and intertransverse ligaments are damaged.…”