Intradural Extramedullary Tumors Research Articles

Exoscopic Minimally Invasive Excision of Intradural Extramedullary Tumor

AbstractSpinal tumors extending up to two levels can be removed using minimally invasive techniques. A microscope is traditionally used as a visualization tool with the tubular-retractor system. An exoscope is a newer optical tool with improved digital resolution, panoramic view, and better ergonomics for surgery. A 36-year-old who presented with paraparesis was diagnosed with intradural extramedullary tumor in the T7-T8 region. A complete tumor resection was possible using tubular retractors and exoscope. The patient recovered clinically. We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this surgery via a minimally invasive method using an exoscope.

Multiple spinal schwannomas of multiple intradural extramedullary tumors: a case report

We describe the case of a 30-year-old male patient who was brought to the hospital's general surgery department with a four-month history of low back pain, numbness, and paraesthesia in both legs, history of weakness in both legs is also present. Magnetic resonance imaging revealed multiple Intradural extramedullary tumors at the C3/C4, D1-D2, D4, and D8 levels- likely nerve sheath tumors (schwannomas). The patient underwent surgery for the removal of tumors. The diagnosis was validated by histopathological examination. Post-operative recovery was uneventful and the patient improved gradually and recovered fully in 10-15 days.

Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies.

Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors.

Functional outcomes in intradural extramedullary spinal tumors.

Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient's quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care. In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS). The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly. The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.

Ventro-Lateral Meningioma of the Cervico-Thoracic Junction: 2-Dimensional Operative Video.

Meningiomas are one of the most common intradural extramedullary tumors.1 Symptoms often arise from cord compression, with gross total resection leading to the most optimal patient outcomes.2,3 Utilization of intraoperative neurophysiological monitoring can increase patient safety through real-time assessment of neural structures and reduce postoperative neurologic complications.4 In this video, we describe the operative techniques for the resection of a meningioma located at the cervico-thoracic junction. A 43-year-old female patient presented with 6 months of bilateral leg numbness and gait disturbances. MRI of the cervical spine demonstrated a cervical thoracic ventral meningioma causing severe cord compression from the bottom of the C6 lamina to the top of the T1 lamina. Surgical resection with intraoperative neuromonitoring with somatosensory-evoked potentials, motor-evoked potentials, and free-running electromyography was recommended. A partial C6-T1 laminectomy was routinely performed, and the dura was opened using a paramedian approach to allow for maximal tumor visualization. The tumor was carefully dissected and debulked, achieving gross total resection. Postoperatively, the patient experienced improvements in preoperative symptoms with no perioperative complications, and the final pathology confirmed the intradural lesion was a meningioma. This video illustrates the surgical technique and management of a spinal meningioma at the cervico-thoracic junction. Patient consent was obtained for their participation in this surgical video.

Lumbar clear cell meningioma mimicking schwannoma 7 years after resection of the same type of intracranial tumor: a case report

BackgroundMeningioma is the second most common intradural extramedullary tumor, following schwannoma. Meningioma is primarily categorized as benign World Health Organization grade 1, but clear cell meningioma is grade 2 of the intermediate malignant category. Clear cell meningiomas are rare, accounting for less than 1% of all meningioma tumors. There is no previous report of multiple intraspinal clear cell meningiomas without dural attachment.Case presentationA 27-year-old Asian male patient presented with lower right extremity pain, and had undergone tumor resection for intracranial clear cell meningioma 7 years previously, with re-resection and radiotherapy for local tumor recurrence at our hospital’s department of neurosurgery being carried out 4 years previously. No recurrence was observed since then. Preoperative lumbar magnetic resonance imaging showed two tumors at the L1 and L4 levels, both mimicking schwannoma with well-defined margins, no dural tail sign and homogeneous internal contrast. Intraoperative findings on tumor resection showed two tumors contiguous with the right L2 and L5 roots, which were not attached to the dura mater, similar to a schwannoma. After gross total resection, the postoperative pathology revealed no nuclear SMARCE1 antibody staining. The patient was diagnosed with clear cell meningioma. The patient’s postoperative course went well, with no symptoms of nerve dropout and no recurrence 2 years after surgery. In this case, both lumbar lesions were well demarcated and spherical in shape, occurring with single roots. Tumor characteristics suggested a primary rather than a metastatic lesion. Clear cell meningioma is characterized by a SMARCE1 mutation and is different from other types of meningiomas.ConclusionTo the best of our knowledge, this is the first report of multiple intraspinal clear cell meningiomas without dural attachment at the lumbar spine after resection of intracranial clear cell meningioma. We speculate that the two tumors were de novo lesions on the basis of the features of the tumors, although they were detected 7 years after the resection of intracranial clear cell meningioma.

Digital 3D Exoscope is Safe and Effective in Surgery for Intradural Extramedullary Tumors: A Comparative Series

Digital 3D exoscopes have been shown to be comparably safe and effective as surgical microscopes in complex microneurosurgical procedures. However, the results of exoscopic spinal tumor surgeries are scarce. The purpose of this study is to compare results of a transition from microscope to exoscope in surgeries for spinal intradural extramedullary tumors. We included all consecutive patients with intradural extramedullary spinal tumors operated on by the senior author during January 2016 to October 2023. The 3D exoscope was used in the latter half of the series from November 2020. We evaluated pre- and postoperative clinical findings, imaging studies, intra- and postoperative events, and analyzed surgical videos from the operations retrospectively. We operated 35 patients (exoscope n= 19, microscope n= 16) for intradural extramedullary tumors (meningioma n= 18, schwannoma n= 12, other n= 5). Tumors in the cervical and thoracic spine were more common than in the lumbar region. The duration of surgery was slightly longer (median 220 vs. 185 minutes) in the exoscope group. However, the rate of gross total resection of the tumor was higher (81% vs. 67%) and the tumors more often located anteriorly to the spinal cord (42% vs. 13%) in the exoscope group. No major complications (i.e., permanent motor deficit or postoperative hematoma) occurred in either group. We saw postoperative gait improvement in 81% and 85% of the patients with preoperative deterioration of gait after exoscopic and microscopic surgeries, respectively. This study demonstrates that exoscope-assisted surgery for spinal intradural extramedullary tumors is comparable in safety and effectiveness to traditional microscopic surgery.

Upstream Effects: Intraoperative Migration of Intradural Extramedullary Tumor After Non–Adjacent Level Stenosis Decompression

A 74 year-old man with back pain, foot numbness, and hip/thigh radiculopathy was found to have an L1-2 intradural extramedullary (IDEM) neoplasm and severe L4-5 stenosis. He was taken to surgery for L4-5 minimally-invasive (MIS) laminectomy for decompression and concomitant L1-2 MIS laminectomy for tumor resection. The L4-5 laminectomy was completed first followed by the separate L1-2 laminectomy. Upon extensive intradural exploration at L1-2, no neoplasm was found. Immediate postoperative imaging showed that the IDEM tumor had migrated caudally by nearly a complete spinal level, presumably as a result of changes in cerebrospinal fluid pressure and resultant shift in intradural contents after the L4-5 laminectomy. The patient was taken back to surgery for successful resection of the IDEM, with improvement in his symptoms.

Differentiation between Anterior and Posterior Roots Using Compound Muscle Action Potential in Intradural Extramedullary Spinal Tumor Surgery.

This study aims to determine the cutoff values for the compound muscle action potential (CMAP) stimulus in anatomically identified anterior (motor nerve) and posterior roots (sensory nerve) during cervical intradural extramedullary tumor surgery. The connection between CMAP data from nerve roots and postoperative neurological symptoms in thoracolumbar tumors was compared with data from cervical lesions. The participants of the study included 22 patients with intradural extramedullary spinal tumors (116 nerve roots). The lowest stimulation intensity to the nerve root at which muscle contraction occurs was defined as the minimal activation intensity (MAI) in the CMAP. In cervical tumors, the MAI was measured after differentiating between the anterior and posterior roots based on the anatomical placement of the dentate ligament and nerve roots. The MAIs for 20 anterior roots in eight cervical tumors were between 0.1 and 0.3 mA, whereas those for 19 posterior roots were between 0.4 and 2.0 mA. The cutoff was <0.4 mA for both the anterior and posterior roots, and sensitivity and specificity were both 100%. In thoracolumbar tumors, the nerve root was severed in 12 of 14 cases. All MAIs were determined to be at the dorsal roots as their scores were higher than the cutoff and did not indicate motor deficits. The MAIs of the anatomically identified anterior and posterior root CMAPs were found to have a cutoff value of <0.4 mA in the cervical lesions. Similar MAI cutoffs were also applicable to thoracolumbar lesions. Thus, CMAP may be useful in detecting anterior and posterior roots in spinal tumor surgery.

Application of unilateral biportal endoscopy technique to resect a thoracic spinal intradural extramedullary meningioma: technical report and review of the literature

BackgroundMeningiomas are common intradural extramedullary spinal tumors, which arise from arachnoid cap cells in the leptomeninges surrounding the brain or spinal cord. Sensory and motor dysfunction as well as pain were the most common presenting symptoms. Surgical resection remains the primary treatment for spinal intradural extramedullary meningiomas. Traditionally, spinal meningiomas excision requires longer skin incision, bilateral subperiosteal muscle stripping, and total laminectomy. We report a new technique for the treatment of thoracic spinal intradural extramedullary meningioma, which involves the use of unilateral biportal endoscopy (UBE) technique to resect the tumor, and reviewed and analyzed relevant literature.Case presentationA 69-year-old female patient presented with back pain accompanied by slowly progressive lower limb paresis, and severe pain in the right lower limb. Magnetic resonance imaging suggests a thoracic spinal intradural extramedullary meningioma. She underwent meningioma resection using UBE technique with complete recovery at the follow-up examination 3 months after surgery.ConclusionThis case confirmed the UBE technique can be a good choice for resection of spinal intradural extramedullary meningioma.

Development of a novel prediction model for differential diagnosis between spinal myxopapillary ependymoma and schwannoma

Spinal myxopapillary ependymoma (MPE) and schwannoma represent clinically distinct intradural extramedullary tumors, albeit with shared and overlapping magnetic resonance imaging (MRI) characteristics. We aimed to identify significant MRI features that can differentiate between MPE and schwannoma and develop a novel prediction model using these features. In this study, 77 patients with MPE (n = 24) or schwannoma (n = 53) who underwent preoperative MRI and surgical removal between January 2012 and December 2022 were included. MRI features, including intratumoral T2 dark signals, subarachnoid hemorrhage (SAH), leptomeningeal seeding, and enhancement patterns, were analyzed. Logistic regression analysis was conducted to distinguish between MPE and schwannomas based on MRI parameters, and a prediction model was developed using significant MRI parameters. The model was validated internally using a stratified tenfold cross-validation. The area under the curve (AUC) was calculated based on the receiver operating characteristic curve analysis. MPEs had a significantly larger mean size (p = 0.0035), higher frequency of intratumoral T2 dark signals (p = 0.0021), associated SAH (p = 0.0377), and leptomeningeal seeding (p = 0.0377). Focal and diffuse heterogeneous enhancement patterns were significantly more common in MPEs (p = 0.0049 and 0.0038, respectively). Multivariable analyses showed that intratumoral T2 dark signal (p = 0.0439) and focal (p = 0.0029) and diffuse enhancement patterns (p = 0.0398) were independent factors. The prediction model showed an AUC of 0.9204 (95% CI 0.8532–0.9876) and the average AUC for internal validation was 0.9210 (95% CI 0.9160–0.9270). MRI provides useful data for differentiating spinal MPEs from schwannomas. The prediction model developed based on the MRI features demonstrated excellent discriminatory performance.

Intradural Extramedullary Spinal Tumors: A Clinical Study and Management without the Aid of Nerve Monitoring

Abstract Background: The incidence of primary spinal cord tumors is less and the true incidence is still not known and various studies are still being done. These tumors are benign and slow growing, and they generally present with pain – either radiculopathy or axial back pain or focal neurological deficits due to the loss of roots, myelopathy from spinal cord compression, or cauda equina symptoms due to chronic compression. Early diagnosis and operation are gratifying as the lesions are mostly benign and can be completely resected as well as preservation of functionality if operated as early as possible. Although rare, an inadvertent neurological injury during surgery is a concerning complication that can potentially be prevented with the assistance of intraoperative nerve monitoring (IONM). This technology enables real-time assessment of spinal cord function by providing feedback from sensory tracts, motor tracts, and individual nerve roots. However, the definitive requirement for IONM in the treatment of a highly curable condition is still under consideration. Objective: our study aims at studying the clinical features of intradural extramedullary tumors and their operative management without nerve monitoring. Material and Methods: Patients with intradural extramedullary (IDEM) spinal cord tumors who fit the inclusion criteria and who were willing to investigations, surgical procedures, and follow up were enrolled in the study, and consent was obtained. Patient assessment was done clinically by McCormick’s Scale and radiologically by magnetic resonance imaging. Patients who underwent operation were followed up. The data was collected and analysed using SPSS software. Results: Nineteen patients were enrolled in the study. The age group ranged from 6 years to 79 years. There were 13 females and 6 males in the study group. The common presenting complaints were backache and upper and lower limb pain. Nine out of the 19 patients underwent operative procedures after thorough radiological and clinical evaluation. Histopathology showed five cases of schwannoma and four cases of meningioma. The mean McCormick’s Scale preoperatively was 4.11, whereas postoperatively, it was 3.10. The operative procedures were performed without the aid of IONM, yet there were no inadvertent intraoperative injuries and postoperative outcomes were good. Our study data were comparable with other studies. Conclusion: IDEM tumors, though technically challenging to operate, have excellent results in terms of outcomes due to their benign characteristics as well as complete resectability. Therefore, it is essential to conduct a comprehensive examination and imaging for patients experiencing backaches and weakness. Following a careful evaluation, early surgical intervention should be considered, as the timeliness of the surgery contributes to enhanced outcomes. The unavailability of nerve monitoring did not portend any added risk of surgery if done meticulously though its aid would make the operative procedure safer and gross resection better.

The efficacy of intraoperative neuromonitoring, including triggered electromyography, in intradural extramedullary spine tumors: a successful case study

The efficacy of intraoperative neuromonitoring, including triggered electromyography, in intradural extramedullary spine tumors: a successful case study

Multifocal thoracic intradural extramedullary anaplastic ependymoma: case report and review of the literature

BackgroundEpendymomas are neuroectodermal tumors that grow from the ependymal cells of the ventricles or the central canal of the spinal cord. When the ependymoma is anaplastic, extramedullary, intradural and multifocal, it is a very rare anatomical entity, same as case described by us.Case presentationA 44-year-old man had been admitted to our hospital for progressive paralysis of both legs over the past 5 weeks. Contrast-enhanced MRI showed intradural extramedullary tumor at T11 with cord compression and an other more little tumor at T6 level, also intradural and extramedullary. The largest lesion was completely removed by laminectomy. Histology documented an anaplastic ependymoma. Contrast-enhanced brain and spinal MRI showed the results of the previous surgery.ConclusionMultifocal intradural extramedullary anaplastic ependymomas are very rare entity. Surgery is the main treatment that can improve prognosis, while radiotherapy is useful, after surgery, in the treatment of residues, recurrences, anaplastic transformations, metastases and multifocal lesions.

SURG-27. 17-YEAR EXPERIENCE OF SURGICAL MANAGEMENT OF INTRADURAL EXTRAMEDULLARY (IDEM) TUMORS: CLINICAL OUTCOMES FROM A LOW- AND MIDDLE-INCOME COUNTRY

Abstract INTRODUCTION Surgical outcomes of intradural extramedullary (IDEM) tumors have been well-reported in the literature from high-income countries. However, limited contemporaneous data from low- and middle-income countries (LMICs) exists. This study sought to analyze the clinical outcomes of all IDEM tumor cases operated during a 17-year period at a resource-limited setting in an LMIC. METHODS The present work was conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A retrospective cohort study was carried out to analyze all IDEM tumor cases, operated upon by a consultant neurosurgeon, during 2004-2021, at a resource-limited setting in Southern India. All patients underwent routine biochemical and radiological investigations, including contrast-enhanced MRI. Laminectomy and tumor resection under the microscope were done without using intraoperative neuro-monitoring. Nerve fibers running through the tumor were sacrificed. Bilateral facet joints were preserved to ensure integrity without spinal fusion. All cases received a dural closure with 5-0 Prolene, with postoperative MRI confirming complete resection. Patients received telephonic and/or in-person follow-up visits. RESULTS 50 patients with a mean age of 46.3 years (range 13-80) were included, with 31 males and 19 females. Their clinical presentation included radiculopathy (78%), radiculomyelopathy (12%), and radiculomyelopathy with bowel and bladder symptoms (10%). Histologically, schwannomas were the most common (52%), followed by neurofibromas (34%), meningiomas (12%), and ependymomas (2%). Two individuals were diagnosed with Neurofibromatosis Type 1. All meningiomas occurred in the thoracic region, with 83.3% of cases being in females. All patients had symptomatic relief postoperatively. No major adverse events occurred, including CSF leaks, permanent neurological deficits, or spinal instability. Recurrence occurred in two 'dumbbell' tumors (4%) at 5 and 7 years after primary excision during follow-up, managed with successful re-resection. CONCLUSION Microsurgical excision of IDEM tumors carries high safety and efficacy, including in resource-limited settings like LMICs.

Expanding the Horizons of Minimally Invasive Spine Surgery: Experience of the Destandau Technique for the Treatment of Multiple Spinal Diseases

ObjectiveMinimally invasive spine surgery is rapidly gaining popularity owing to its versatile nature. Traditionally prolapsed disc has been the most common pathology targeted using this technique. However, its utility for various other pathologies has also been shown in studies. Here we present our experience of using this technique for various spinal pathologies apart from prolapsed discs. MethodsThis is a retrospective study in which patients operated by a single surgeon from January 2019 to April 2023 were included. Cases which required conversion to open technique were excluded. Intraoperative findings and post-operative courses were obtained from patient records. ResultsA total of 47 cases were included in the study, of which 29 were male and 18 were female. Various pathologies treated include- intradural extramedullary tumors – 23, hypertrophied/ossified ligamentum flavum- 9, arachnoid cysts- 6, dermoid/epidermoid- 4, detethering of cord- 3 and posterior cervical decompression for an ossified posterior longitudinal ligament in 2 patients. The average duration of surgery was 2.1+1.2 hrs and the mean intraoperative blood loss was 138.4+ 59.1 ml. The mean hospital stay was 2.3+0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients. ConclusionsMinimally invasive techniques for dealing with multiple pathologies involving the spine are as good as traditional open techniques with some additional advantages of lesser tissue trauma, early return to work etc. However, one must overcome the steep learning curve before adopting them in day-to-day practice.

Radiographic and clinical features of thoracic intradural extramedullary epidermoid tumor: Illustrative case

Spinal epidermoid tumors are uncommon benign neoplastic lesions arising from heterotopic epidermal rest-cells. These lesions rarely occur in the thoracic region (&lt;0.8%) and can present with symptoms of spinal cord and nerve root compression.

Spinal Cellular Schwannoma: A Case Report of Acute Post-Traumatic Paralysis

This case report describes a 64-year-old female patient who presented to the emergency department with lower back pain, bilateral leg pain, and numbness. Magnetic resonance imaging revealed a mass-like lesion at the L2 level, which was surgically removed and was found to be a cellular schwannoma upon histopathological examination. The patient exhibited immediate postoperative improvement and was referred for rehabilitation. This case highlights the importance of considering cellular schwannoma as a possible diagnosis in patients with intradural extramedullary tumors causing compressive symptoms.

Effectiveness of intraoperative monitoring of the bulbocavernosus reflex for predicting postoperative pelvic disorders in the surgical treatment of distal spine tumors

The study evaluated the diagnostic effectiveness of changes in the parameters of the bulbocavernous reflex during intraoperative neurophysiological monitoring in the surgical treatment of caudal spinal cord tumors. The study was performed during examinations and neurosurgical treatment of 58 patients suffering from intradural extramedullary and intramedullary tumors of the caudal spinal cord. In 23 (39.7%) patients, the tumors were localized at the level of the lower thoraciclumbar spine (Th11L1), and in 35 (60.3%) patients, they were at the level of the lumbosacral spine (L2S2). Pelvic organ dysfunction was assessed based on the extent of neurogenic bladder symptoms before surgery, 1014 days after surgery, and a year later. The bulbocavernous reflex was recorded in response to genital nerve stimulation, with a series of three pulses lasting 0.5 ms each, and the repetition rate of the series was 2 Hz. The intensity of the stimulation current was 75% of the maximum intensity. The bulbocavernous reflex was registered from the external anal sphincter muscles. During intraoperative monitoring, the bulbocavernous reflex remained stable in 49 patients. In this group, pelvic dysfunction was not observed immediately or 12 months after surgery. Persistent changes in motor response parameters were registered in nine patients; seven and eight cases of dysuric disorders were observed immediately after surgery and 12 months after surgery, respectively. Persistent changes in the bulbocavernous reflex during intraoperative monitoring were significantly more often associated with pelvic organ dysfunction immediately after surgery (2 = 36,323; p 0.001) and 12 months after surgery (2 = 32,284; p 0.001). The sensitivity and specificity of intraoperative monitoring of the bulbocavernous reflex in assessing the risk of pelvic dysfunction in the postoperative period were 96.1% and 100%, respectively. In general, postoperative pelvic organ dysfunction is a frequent cause of neurological complications following surgical treatment of caudal spine tumors. Therefore, during surgery, neurophysiological monitoring is implemented to control pelvic organ functions, including the registration of the bulbocavernous reflex.

Pediatric Dorsal Intradural Extra-Medullary Epidermoid Cyst (Non-Dysraphic): An Illustrative Case with Literature Review

A spinal epidermoid cyst is a rare congenital tumour that may be associated with spinal dysraphism. Congenital spinal epidermoid cysts without spinal dysraphism are rare. Here we are reporting a rare and interesting case of thoracic Intradural extra-medullary epidermoid cyst not associated with spinal dysraphism. Epidermoid cysts (EC) represent less than 1.0% and are rarely seen as an intradural extra-medullary spinal cord tumor.  Preoperative Clinico- Radiological assumption is important for surgical planning. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):88-95