Intradural Spinal Cord Tumors Surgical Experience with Modified Sheehan Technique

Abstract

Background: Primary spinal cord tumors are rare neoplasms that lead to significant morbidities. They representing about 2–4% of all tumors that affect the central nervous system. According to their relation to the dura, and spinal cord they are classified into extradural, intradural extramedullary and intradural intramedullary tumors. Magnetic resonance imaging is the radiological investigation of choice for the diagnosis of intradural tumors both intra and extramedullary. Surgical excision is the best treatment modality in the majority of patients. Patients and Methods: This is a retrospective study of thirty patients, fifteen males, and fifteen females suffering spinal cord tumors. Median age at diagnosis 41years. Follow up period range from 6months to 43 months with average 24 months. Neurological assessment of the patients carried out by ASIA (American spinal injury association) scoring. Radiological evaluation occurs through MRI (magnetic resonance imaging) with contrast. Of the studied group seven cases were intradural intramedullary and twenty-three cases were intradural extramedullary. The utilized surgical approach was modified Sheehan technique and all the cases were operated by a single surgeon to avoid the inter surgeon variability. Histopathological assessment was done for the excised specimen for all patients. Results: Thoracic region most affected 53.3%, followed by cervical 23.4%, then lumbar (20%) regions. 76.7% intradural extramedullary, and 23.3% intradural intramedullary. Schwannoma 43.3% and Meningioma (20%) were the most pathology. ASIA group C decreased from 40% to 6.7%, and ASIA group D decreased from 60% to 26.7%, and we got a new ASIA group E 66.7% didn’t exist before surgery. Conclusion: The utilized surgical technique is very effective and safe as we get wide corridor for tumor excision, so increasing the effectiveness of operative microscopy and other operative tools, and improve the surgical outcome as noticed in postoperative neurological status.