Intradural Extramedullary Tumors Research Articles

Evaluation of prognostic factors and outcomes following intradural Extramedullary spinal Tumor Resection

Introduction: Intradural extramedullary spinal tumors are usually treated with surgical excision in order to achieve functional improvement and quality of life. Objective: The aim of this study was to identify prognostic factors and to evaluate the outcome of surgical treatment. Methods: Data from medical records of 49 patients who underwent surgery for intradural extramedullary spinal tumor in a single institution - Hospital da Restauração - were collected. The outcome of the patients was assessed through the McCormick Scale and EuroQol-5 dimensions (EQ-5D) in the preoperative period and last follow-up. Results: Significant improvement in the functional status after surgical treatment was observed. There was 93.3% of improvement and 6.7% of stability. A worse functional result was related to a longer symptoms duration (p = 0.074). Age, symptoms duration, tumor location, histopathological diagnosis, and McCormick preoperative had no significant association with the McCormick at final follow-up (p>0.05). Conclusion: Surgical treatment significantly improved the quality of life and neurological deficits of the vast majority of patients. Age, symptoms duration, tumor location, histopathological diagnosis and McCormick preoperative grade did not present prognostic correlation in this study.

Intradural Extramedullary Spinal En-Plaque Meningioma With Calcification: A Case Report And Literature Review

Abstract
 Introduction: Intradural extramedullary (IDEM) tumors are benign neoplasms arising in the spinal canal about two-thirds of primary spinal tumors and 15% of tumors affecting the Central Nervous System. Spinal en-plaque meningioma is a type that grows in a sheet-like or collar-like, and incidence in the literature only ranging from 0.1% to 3.1%. Pain is the most clinical symptom, weakness and sensory changes also occur frequently. Magnetic resonance imaging (MRI) is the standard modality for the radiologic diagnosis of meningioma.
 Case Report: A patient, 35 years old man with a diagnosis of intradural extramedullary spinal meningioma (IDEM) en-plaque with calcification, confirmed by the symptoms, workups such as spinal MRI, and intra-operative findings. The patient was successfully treated surgically with laminectomy and total tumor resection with a posterior approach.
 Discussion: Spinal en-plaque meningioma is a type that grows in a sheet-like or collar-like manner around the spinal cord can involve dura extensively with significant neurological deficits. Patient was with lower limb weakness, and had a history of back pain radiating to the right limb for the last 1 year. Spinal meningiomas are primarily found in the Intradural Extramedullary, and the tumor diagnosis is typically fairly straight forward based on radiologic findings. Meningiomas are most commonly found in the thoracic region of the spine. In this case from MRI Imaging was revealed a mass in thoracic region of the spine pressing the spinal cord anteriorly. The management of spinal en-plaque meningioma is tumor resection surgery. A retrospective study suggested a significant improvement in neurological deficit post-tumor resection on patients with spinal IDEM tumor.
 Conclusion: Spinal meningioma is a reasonably frequently found case of a spinal tumor but spinal en-plaque meningiomas are rarely found. MRI scan is the radiological gold standar diagnose spinal en-plaque meningiomas. Patient was successfully treated by total tumor resection using the laminectomy method and tumor resection with a posterior approach without any postoperative complications observed.

Impact of general anaesthesia on parameters of bulbocavernosus reflex

Dysfunction of the pelvic organs in tumor lesions of the spinal cord is up to 20%. Registration of the bulbocavernosus reflex is performed to assess the integrity of the segmental apparatus of the spinal cord. Polymodal neurophysiological monitoring includes registration of the bulbocavernosus reflex during surgery of spinal cord tumors. The effect of the components of general anesthesia on the parameters of the bulbocavernosus reflex varies significantly according to various medical sources. The aim of the work was to compare the effect of inhalation anesthesia (sevoflurane) and total intravenous anesthesia (propofol) on the parameters of the bulbocavernosus reflex in the surgical treatment of spinal cord tumors. Thirty patients with intradural extramedullary and intramedullary tumors of the spinal cord at the level of Th11–S2 vertebrae were included in the study. The amplitude-frequency parameters of the bulbocavernosus reflex and the threshold intensity of stimulation were assessed in the study. The results of the study demonstrate that intraoperative registration of the bulbocavernosus reflex during resection of tumors of the distal spinal cord can be performed both with inhalation and total intravenous anesthesia. A sustained motor response of the bulbocavernosus reflex requires a higher intensity of stimulation with inhalation anesthesia with sevoflurane than with total intravenous anesthesia. If during the operation the depth of propofol's anesthesia increases by 1 mg/kg/h, then it is necessary to increase the current strength during stimulation by 10–11 mA.

Cervical myelopathy due to an endodermal intraspinal cyst in a two-year-old child: a case report

Background: Cervical myelopathy is commonly seen in the older population caused by a degenerative process, but in a rare case, it can be seen in the pediatric population due to uncommon causes, such as an intraspinal cyst. This case report aims to discuss a rare case of cervical myelopathy due to an endodermal cyst in a two-year-old child.Case Presentation: A 2-year-old child with limited neck movement and abnormal body posture from 6 months before admission to the hospital. Spine trauma and other histories of disease were denied. There was no deformity, swelling, hematoma, and wound on the vertebra region from physical examinations. The motoric function was found weaker on the upper and lower right extremities, and pathological reflex was found on both sides. MRI examination showed an intradural extra-medullar space-occupying lesion on the C2-C5 level of the spine. At first, the patient was diagnosed with cervical myelopathy due to an intradural extramedullary tumor at level C2-C5. Excision of the cyst, posterior decompression, and laminectomy was done in this patient. The postoperative histopathological result showed an intraspinal cyst with an endodermal type cyst.Conclusion. This case study was first diagnosed due to an intradural extramedullary tumor, which appears to be a benign intraspinal cyst from the histopathological result. The surgical treatment results in a favorable outcome, but a routine follow-up should monitor the improvement or long-term neurological decline.

Anterior Transcorporeal Approach for Cervical Metastatic Melanoma Resection Guided by O-Arm–Navigated Intraoperative Computed Tomography

Surgical resection of the ventrally located tumor in the cervical spinal region is technically challenging and usually requires a traditional extensive approach. To reduce collateral injury and preserve cervical stability, the anterior transcorporeal approach under navigated guidance is an alternative minimally invasive technique. To describe a minimally invasive transcorporeal approach for cervical intradural extramedullary tumor resection and spinal cord decompression. Previous literature regarding available treatment options was reviewed. A patient with known intracranial malignant melanoma presented with severe myelopathy from metastatic melanoma compressing the cervical cord. The anterior transcorporeal approach for total tumor resection and spinal cord decompression under a microscope was planned. Under spinal navigation, small bone tunneling was performed to expose and remove the tumor without compromising cervical stability. The melanoma resection was successfully performed without complications. Myelopathic symptoms were significantly improved with the absence of instability or local recurrence at the long-term follow-up. We present the anterior transcorporeal approach that can be used to resect the tumor in the ventral cervical region and effectively decompress the cervical cord without complications. Moreover, this approach is the minimally invasive surgical technique that preserves spinal stability, minimizes bleeding, and shortens the hospital stay.

Improvement in Quality of Life Following Surgical Resection of Benign Intradural Extramedullary Tumors: A Prospective Evaluation of Patient-Reported Outcomes

Newman, William C MD; Berry-Candelario, John MD; Villavieja, Jemma BS; Reiner, Anne S MPH; Bilsky, Mark H MD; Laufer, Ilya MD, MS; Barzilai, Ori MD

Spinal Cord Tumors:Classification, Treatment, and Prognosis

Spinal cord tumors are classified into three types according to the site of origin: epidural tumors, intradural extramedullary tumors, and intramedullary tumors. It is important to understand the common tumors at each site. Most intradural extramedullary tumors are benign schwannomas or meningiomas and need surgical removal. For intramedullary tumors, it is important to determine the type of tumor and the site of origin before selecting the surgical approach.

Novel Dural-Splitting Operative Technique for Excision of Ventrally Located Spinal Meningiomas

Spinal meningiomas are one of the frequently seen intradural extramedullary spinal tumors. They are almost always World Health Organization grade I, and a complete removal of the tumor can be curative. However, ventrally located spinal meningioma removal can be challenging due to the position in front of the spinal cord through a narrow corridor provided by routine dorsal approaches. Incomplete excision of the relatively inaccessible dural attachment can consequently lead to recurrence. We describe a safe and reproducible technique used to achieve Simpson grade I removal of ventrally located spinal meningioma. Since the spinal dura can be easily divided into inner and outer layers and the tumor usually spares the outer layer, we developed a simple technique to achieve total resection of the tumor and involved dura while leaving the outer dural layer intact. An advantage of this procedure is that it exploits an interdural approach to allow early devascularization of the tumor without cord manipulation and provides access to the ventral dura to achieve Simpson grade I excision. Another advantage is complete dural closure to minimize postoperative cerebrospinal fluid leak or ventral cord herniation without the need for dural substitutes. Its novel interdural approach can be used for all ages and all spinal meningiomas.

Low Back Pain In A Basketball Player

HISTORY: 16 year old basketball player presenting with low back pain for 1 year, worsening for 1 month, with night pain for 1 week. No acute injury. Pain at low back and sacrum, worse with flexion. Denies radicular symptoms in lower extremities, bowel/bladder incontinence, gait instability, saddle anesthesia. Recently developed fatigue, anorexia, and urinary hesitancy - requires bladder pressure for voiding. ED eval with neg x-rays; PCP eval with urgent referral to Ortho clinic. PHYSICAL EXAMINATION: Neuro: CN II-XII grossly intact. Normal muscle bulk/tone, slightly guarded gait. MSK: Lumbar spine/Sacrum/Coccyx. Inspection: No ecchymosis or deformity. Palpation: TTP at L2-L5 spinous processes, sacrum, coccyx. No TTP at SI joints, iliac crests, thoracic spine. ROM: 40 deg flexion with pain, 20 deg extension, 20 deg lat bending, 20 deg lat rotation. Neurovascular: Distally NVI, brisk pulses, 2 sec cap refill, sensation intact. 2+ DTRs bilateral patellar and Achilles tendons. No clonus. Special maneuvers: Neg Hyperextension test in prone, Neg SLR test. Neg Slump test. Neg FABER test. Hip ROM full, pain free. Anal sphincter tone normal, perineum sensation intact per PCP. DIFFERENTIAL DIAGNOSIS: 1. Spondylolysis/Spondylolisthesis 2. Syringomyelia 3. Ewing Sarcoma/Osteosarcoma TEST AND RESULTS: XR Sacrum/Coccyx: No visible fracture or malalignment. No significant abnormality in visualized portion of the lumbar spine. Soft tissues radiographically normal. MRI Pelvis: Intradural mass extending at S2-S4 level (measures 1.3 x 2.9 x 5.5 cm), likely impinging cauda equine roots at these levels. Mass causes scalloping of posterior aspects of S3-S4 vertebral bodies. Mass heterogeneous on T1/T2 with peripheral enhancement, but no definite centralenhancement. No definite extension through sacral ala. May represent filum terminale (myxopapillary) ependymoma. Meningioma or nerve sheath tumors less likely, given lack of central enhancement. FINAL WORKING DIAGNOSIS: Ewing Sarcoma TREATMENT AND OUTCOMES: 1. Admission to Neurosurgery. Sacral laminectomy/resection of intradural extramedullary spine tumor 2. Radiation therapy complete (5 mos) 3. Chemotherapy complete (10 mos) 4. Pediatric Urology: urinary hesitancy resolved 5. Surveillance q 3 months with serial imaging 6. Return to activity as tolerated

Intradural Spinal Cord Tumors Surgical Experience with Modified Sheehan Technique

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.

Intradural extramedullary anaplastic ependymoma in dorsal spinal cord: Case report

Ependymomas are common intramedullary spinal tumors but there are very few reports of this tumour presenting with exophytic growth patterns mimicking as intradural extramedullary (IDEM) tumors [1]. Intradural extramedullary tumors are more of an intra-operative finding rather than a clinical diagnosis. The tumor pathological features are usually benign and they most commonly arise from the central canal of the spinal cord, the conus medullaris or the filum terminale [1]. In contrast, intra and extramedullary ependymomas are reported very rarely and have wide variety of histological features [3]. We present a case of recurrent spinal anaplastic ependymoma with an extramedullary exophytic lesions as well. Intra-operatively there was poor delineation between the lesion and the spinal cord.

Outcomes of the surgical resection of intradural extramedullary tumors

Aim To evaluate the postoperative status after the tumor resection and compare it with the preoperative status. Background The intradural extramedullary tumors remain curable diseases and carry a favorable outcome. Early diagnosis is crucial to improve the outcome. Resection of the intradural extramedullary tumors improves the pain and the functional outcome of the patients. Patients and methods A retrospective study was done in the Neurosurgery Department, Sohag Faculty of Medicine, to patients diagnosed with intradural extramedullary tumors confirmed by MRI spine between April 2014 and April 2018. Forty-two cases were presented with female predominance, with mean age 46.6 ± 17 years with different presentations. They were operated and follow-up was done for 1 year postoperatively. They were evaluated preoperatively regarding pain, motor, and sphincteric function. Results The most frequent symptom was back and leg pain (88.1%), followed by paraparesis (23.8%), sensory disturbances in seven (16.7%) patients, and urinary incontinence in seven (16.7%) patients. The most common pathology was schwannoma (61.9%). Surgical resection improves the outcome in 35 (83.3%) patients. The dorsal spine was mostly affected in 30 patients followed by the lumbar spine in nine patients. The most effective prognostic factor was the early surgical intervention. Complications were reported in 19 patients, including cerebrospinal fluid leak, urinary incontinence, and wound infection. Conclusion These types of tumors have excellent results after excision. We recommend early intervention, irrespective of the tumor location or the pathology. After total excision, marked improvement regarding pain and neurological function was reported, while the recurrence rate was less than 2.5%. Prognostic factors include tumor extension, time of intervention, and Simpson grade of excision.

Clinicopathological Study of Intradural Extramedullary Spinal Tumors and Its Correlation With Functional Outcome.

IntroductionIntradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of largely benign intraspinal neoplasms. These are amenable to gross total excision and usually carry a good functional outcome.MethodsIn this study, we reviewed the surgical outcomes of 35 patients who underwent excision of intradural extramedullary tumors. Patient demographics, severity and duration of symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were collected. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel and Nurick grading. The back pain was assessed with help of the Denis pain scale (DPS).ResultsThe histopathological outcomes of the study were as follows: six patients of neurofibroma, 12 cases of schwannoma, nine cases of meningiomas, three cases of ependymoma, one case of dorsal neurenteric cyst, two cases of epidermoid cyst, one case of cauda equina paraganglioma, and one case of filum terminale dermoid cyst. Paresthesia/numbness were the commonest symptoms (88.6%), weakness of limbs in (80%), sphincter dysfunction in 15 patients (42.9%), and paraplegia was seen in three patients (8.57%). The complications encountered were - one case each of cerebrospinal fluid (CSF) leak, surgical site infection, and pseudomeningocele. The percentage of spinal canal occupied ranged from 71-94%. The mean percentage of the spinal canal occupied by the tumor was 81.8%.In our series, 77.14% of patients (p<0.0001) had good functional outcomes as per improvement in Frankel score. The DPS and Nurick score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significant functional improvement was noted at the one-week, one-month, and one-year follow-up, with a p-value of <0.0001.ConclusionsThe IDEM tumors are usually benign and are readily detected by contrast-enhanced MRI scans. These have excellent surgical outcomes with some exceptions. Greater canal occupancy and a longer duration of symptoms are usually seen to correspond with suboptimal functional outcomes.

ДИФФЕРЕНЦИАЛЬНЫЕ ПРИЗНАКИ ПРИ ДИАГНОСТИКЕ КОНСТРИКТИВНОЙ МИЕЛОПАТИИ И СПИНАЛЬНЫХ НОВООБРАЗОВАНИЙ В ГРУДОПОЯСНИЧНОМ ОТДЕЛЕ

Neoplasms of the spinal column and spinal cord, depending on their localization relative to the spinal cord and its membranes, are classified into extradural, intradural extramedullary and intramedullary. Extradural tumors are located outside the dura mater. This category includes tumors of the vertebral bodies and tumors lying in the extradural space of the spinal canal. Intradural extramedullary tumors are found within the dura but outside the spinal parenchyma. Intramedullary tumors originate within the spinal cord and are the rarest group of spinal tumors. The aim of the study is to determine the criteria for the differential diagnosis of studied pathology.

Characteristics of Tc-MEP Waveforms for Different Locations of Intradural Extramedullary Tumors: A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.

Prospective multicenter study. To examine transcranial motor-evoked potential (Tc-MEP) waveforms in intraoperative neurophysiological monitoring in surgery for intradural extramedullary (IDEM) tumors, focused on the characteristics for cervical, thoracic, and conus lesions. IDEM tumors are normally curable after resection, but neurological deterioration may occur after surgery. Intraoperative neurophysiological monitoring using Tc-MEPs during surgery is important for timely detection of possible neurological injury. The subjects were 233 patients with IDEM tumors treated surgically with Tc-MEP monitoring at 9 centers. The alarm threshold was ≥70% waveform deterioration from baseline. A case with a Tc-MEP alert that normalized and had no new motor deficits postoperatively was defined as a rescue case. A deterioration of manual muscle test score ≥1 compared to the preoperative value was defined as postoperative worsening of motor status. The 233 patients (92 males, 39%) had a mean age of 58.1 ± 18.1 years, and 185 (79%), 46 (20%), and 2 (1%) had schwannoma, meningioma, and neurofibroma. These lesions had cervical (C1-7), thoracic (Th1-10), and conus (Th11-L2) locations in 82 (35%), 96 (41%), and 55 (24%) cases. There were no significant differences in preoperative motor deficit among the lesion levels. Thoracic lesions had a significantly higher rate of poor baseline waveform derivation (0% cervical, 6% thoracic, 0% conus, P < 0.05) and significantly more frequent intraoperative alarms (20%, 31%, 15%, P < 0.05). Use of Tc-MEPs for predicting neurological deficits after IDEM surgery had sensitivity of 87% and specificity of 89%; however, the positive predictive value was low. Poor derivation of waveforms, appearance of alarms, and worse final waveforms were all significantly more frequent for thoracic lesions. Thus, amplification of the waveform amplitude, using multimodal monitoring, and more appropriate interventions after an alarm may be particularly important in surgery for thoracic IDEM tumors.Level of Evidence: 3.

Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors.

Intradural extramedullary (IDEM) spinal cord tumors are two thirds of all spinal tumors. We have prospectively analyzed the importance of the tumor occupancy ratio as a factor for predicting the course of the disease and in prognosticating the surgical outcome in patients with IDEM tumors. We prospectively analyzed 44 consecutive cases of IDEM tumors, diagnosed as cervical, thoracic, and lumbar IDEM tumors (excluding conus/cauda equina lesion) by magnetic resonance imaging (MRI), that were operated on at our institution between 2014 and 2016. We measured the tumor occupancy ratio and noted the sagittal and axial location of the tumor in the preoperative MRI and performed the laminectomy and unilateral medial facetectomy. A primary outcome has been noted according to the gait disability score in the preoperative period and in the follow-up period of 1 year. In the statistical analysis, categorical variables were compared using a chi-square test, and an analysis of variance and student t tests were used for the continuous variables. P < .05 was considered statistically significant. The tumor occupancy ratio showed a significant association to the preoperative gait disability score (P < .001) and also predicted that the surgical outcome is much better in patients with tumors with a low tumor occupancy ratio than in patients with tumors with a high occupancy ratio (P < .001). No difference in the tumor occupancy ratio was noted in 2 different pathological tumors, and there was also no difference in the tumor occupancy ratio at different sagittal and axial locations of the tumor. Tumor occupancy ratio has shown a significant impact on the preoperative course and also predicts the surgical outcome in patients with IDEM tumors. Hence, it is an important imaging characteristic to prognosticate the outcome in IDEM tumors and should be noted in each case.

A transpedicular approach to complex ventrally situated thoracic intradural extramedullary tumors: technique, indications, and multiinstitutional case series.

Ventrally situated thoracic intradural extramedullary tumors are surgically challenging and difficult to access, and they may be complicated by extensive adhesions and calcifications. Selecting an approach for adequate ventral access is key to complete resection and optimization of outcomes. The authors present a case series of patients who underwent resection of ventral thoracic intradural extramedullary tumors and discuss indications and considerations for this technique. Additionally, they describe the use of a posterolateral transpedicular approach for resection of ventral thoracic intradural extramedullary tumors compared with other techniques, and they summarize the literature supporting its application. From May 2017 to August 2020, 5 patients with ventral thoracic intradural extramedullary tumors underwent resection at one of the two academic institutions. Patient ages ranged from 47 to 75 (mean 63.4) years. All tumors were diagnosed as meningiomas or schwannomas by histological examination. Three of the 5 patients had evidence of partial or extensive tumor calcification. Four of the 5 patients underwent an initial posterolateral transpedicular approach for resection, with positive radiographic and clinical outcomes from surgery. One patient initially underwent an unsuccessful traditional direct posterior approach and required additional resection 2 years later after interval disease progression. There were no postoperative wound infections, CSF leaks, or other complications related to the transpedicular approach. Posterolateral transpedicular tumor resection is a safe technique for the treatment of complex ventrally situated thoracic intradural extramedullary tumors compared with the direct posterior approach. Anecdotally, this approach appears to be particularly beneficial in patients with calcified tumors.

Improvement in Quality of Life Following Surgical Resection of Benign Intradural Extramedullary Tumors: A Prospective Evaluation of Patient-Reported Outcomes.

Historically, symptomatic, benign intradural extramedullary (IDEM) spine tumors have been managed with surgical resection. However, minimal robust data regarding patient-reported outcomes (PROs) following treatment of symptomatic lesions exists. Moreover, there are increasing reports of radiosurgical management of these lesions without robust health-related quality of life data. To prospectively analyze PROs among patients with benign IDEM spine tumors undergoing surgical resection to define the symptomatic efficacy of surgery. Prospective, single-center observational cohort study of patients with benign IDEM spine tumors undergoing open surgical resection. Pre- and postoperative Brief Pain Index (BPI) and MD Anderson Symptom Inventory (MDASI) questionnaires were used to quantitatively assess their symptom control after surgical intervention. Matched pairs were analyzed with the Wilcoxon signed-rank test. A total of 57 patients met inclusion criteria with both pre- and postoperative PROs. There were 35 schwannomas, 18 meningiomas, 2 neurofibromas, 1 paraganglioma, and 1 mixed schwannoma/neurofibroma. Most patients were American Spinal Injury Association Impairment (ASIA) E (93%) with high-grade spinal cord compression (77%), and underwent either a 2 or 3 level laminectomy (84%). Surgical resection resulted in statistically significant improvement in all 3 composite BPI constructs of pain-severity, pain-interference, and overall patient pain experience (P<.0001). Surgical resection resulted in statistically significant improvements in all composite scores for the MDASI core symptom severity, spine tumor, and disease interference constructs (P<.01). Three patients (5%) had postoperative complications requiring surgical interventions (2 wound revisions and 1 ventriculo-peritoneal shunt). Surgical resection of IDEM spine tumors provides rapid, significant, and durable improvement in PROs.

Endoscopic spine surgery for cervicothoracic spine neurofibroma: a case report

Introduction: Spinal tumors are rare lesions. The incidence of spinal tumors is about 0.5-2.5 cases per 100,000 population per year.1 Thirty percent of spinal tumors are located intradural. Twenty to thirty percent of intradural tumors are schwannoma and spinal neurofibroma.2 Surgery is the leading choice for schwannomas and neurofibromas that grow progressively or cause neurological deficits.2,3,4 Currently, minimally invasive surgery is developing rapidly, including minimally invasive surgery on spine surgery.Better outcomes are expected in endoscopic spine surgery compared to conventional spine surgery techniques.This paper aims to provide an overview of endoscopic procedures for the surgical removal of spinal tumors.Case description: A 59-year-old man presented paraplegia of both lower limbs. The patient complained difficulty walking for nine months before admitted to the hospital. The patient also complained of difficulty moving both of his legs, burning pain sensation, pain and numbness sensation that radiates from chest region to both of his toes, he felt that his chest was tied, and he complained hard to breathe when he feels pain. Complaints are getting worse until the patient was unable to walk. We found intra-dural extramedullary lesion from the MRI that was suspicious of a nerve cell sheath tumor. The patient underwent surgical treatment for tumor removal with an endoscopic technique, the cancer was complete. From the histopathology, the tumor was a neurofibroma tumor.Conclusion: Neurofibroma is one of the most frequently intradural extramedullary spinal tumors. Good imaging can guide the diagnosis and a good plan for manage patients with spinal tumors. Complete tumor resection provides a better prognosis in patients with neurofibromas. With endoscopic techniques, total spinal tumor removal surgery can be performed. The surgical procedure for spinal tumors using an endoscopic approach may be an option for spinal neurofibromas patients.

Laminectomy versus Unilateral Hemilaminectomy for the Removal of Intraspinal Schwannoma: Experience of a Single Institution and Review of Literature.

Spinal schwannomas are benign slow-growing tumors, and gross total resection is the gold standard of treatment. The conventional surgical approach is laminectomy, which provides a wide working area. Today minimally invasive surgery (MIS) is popular because it is associated with shorter hospital stay, less operative blood loss, minimized tissue traumas and relative postoperative pain, and, and spine surgery, avoidance of spinal instability. From January 2016 to December 2019, we operated on 40 patients with spinal intradural extramedullary tumor (schwannoma) with laminectomy or hemilaminectomy. Baseline medical data, including patients' sex and age, tumor location, days of postoperative bed rest, operative time, length of hospitalization, and 1-month visual analog scale (VAS) value were collected and analyzed. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, Texas, United States). Hemilaminectomy was associated with faster operative time (p < 0.001), shorter postoperative time spent in bed (p < 0.001), and shorter hospitalization (p < 0.001). At 1-month follow-up, the mean VAS score was 4.6 (1.7) among the laminectomy patients and 2.5 (1.3) among the hemilaminectomy patients (p < 0.001). Postoperative complications occurred in 1 (7.7%) and 7 (25.9%) patients in the hemilaminectomy and laminectomy groups, respectively (p = 0.177). Unilateral hemilaminectomy has significant advantages compared with laminectomy in spinal schwannoma surgery including shorter operative time, less time spent in bed, shorter hospitalization, and less postoperative pain.