Intradural Cauda Equina Tumors: Early Surgical Experience of a Small Neurosurgical Team

Abstract

Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. Purpose: To present our experience and outcome of management of cauda equina tumors. Study Design: A retrospective clinical case study. Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre- and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. Conclusion: The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)