Intradural Extramedullary Tumors Research Articles

Laminoplasty vs laminectomy in the surgical management of spinal intradural extramedullary tumors

BackgroundLaminectomy and laminoplasty have been widely used for patients with spinal cord tumors. Spinal tumors comprise around 5–10% of all central nervous tumors, with 70–80% of these being intradural extramedullary in location. Surgery is the main treatment modality for spinal tumors. In this case series, we aimed to compare the laminectomy and laminoplasty procedure in the surgical management of intradural extramedullary spinal tumors and analyze the advantages and disadvantages of both the procedures.Materials and methodThe clinical and radiological data of patients who underwent laminectomy or laminoplasty for spinal cord tumors were retrospectively analyzed. Out of the 56 patients undergoing surgery for spinal IDEM, “En-bloc osteoplastic laminoplasty” with titanium microplates was performed in 26 patients, while 26 patients had laminectomy without disrupting the facet joints, and 4 patients required fusion with screws and rods along with laminectomy. All these patients were followed for one year. Patient data, including surgical time, blood loss, length of hospital stay, post-operative complications, post-operative neurological status, post-operative pain, and preoperative and post-operative deformity, were gathered and analyzed in both the laminectomy and laminoplasty groups.ResultsOf the total, there were 23 males and 33 females, with a mean age of 39.47 ± 13.65 years in the laminectomy group and 37.23 ± 12.03 in the laminoplasty group. The average operative time for laminectomy procedures was 138.86 ± 10.90 min, while it was 145.19 ± 9.54 in the laminoplasty group. The average length of hospital stay in the laminectomy group was 6.50 ± 2.01 days, and 5.08 ± 1.47 days in the laminoplasty group. The mean blood loss in laminectomy group was 118 ± 15.05 ml, whereas in laminoplasty group the mean blood loss was around 110 ± 12.46 ml. Also, laminoplasty group had a lower incidence of post-operative deformity.ConclusionsLaminoplasty is a constructive technique in the management of intradural extramedullary spinal tumors, associated with fewer post-operative complications, lower incidence of new post-operative deformities or worsening of preoperative deformities, and a shorter duration of post-operative pain. Additionally, it alleviates the need for additional instrumentation, thereby avoiding an extra financial burden while enhancing the quality of life for the patient. A high-quality randomized controlled trial with long-term follow-up is necessary to validate the findings of this innovative technique.

Intradural extramedullary double primary ependymoma and meningioma rare condition: Case report and literature review.

Ependymomas are commonly prevalent intramedullary neoplasms in adults, with hardly any cases of exophytic extramedullary ependymoma being reported. Meningiomas, on the contrary, are one of the most common intradural extramedullary (IDEM) tumors. However, the occurrence of both IDEM tumors simultaneously is extremely rare. A 63-year-old female who presented with pain and numbness in both lower limbs, and symptoms rapidly progressed over the past 5 months. Based on the patient's clinical symptoms and imaging features, we conducted pathological examination and genetic testing, ultimately confirming that the patient had IDEM double primary ependymoma and meningioma. Surgery was performed to remove double spinal tumors, decompress spinal nerve roots, and perform laminectomy, and she was treated with electrocardiogram monitoring, antibiotics, hemostasis, and antiedema therapy. Histopathology confirmed World Health Organization grade II ependymoma at L2 and World Health Organization grade I meningioma at T12-L1. MYCN amplification and other genetic alterations were absent. Postoperative recovery was favorable, with no recurrence at 6-month follow-up. This is the first reported case of IDEM double primary ependymoma and meningioma, highlighting the rarity of such cases and the importance of thorough diagnostic workup and surgical excision for IDEM tumors. Genetic analysis adds to the understanding of these rare tumors and guides management strategies.

Factors Determining Rehabilitation Needs After Intradural Spinal Tumor Surgery: A Prospective Study.

While most studies on the postoperative condition of patients with spinal cord tumors describe long-term outcomes, data are needed on immediate surgical outcomes demanding rehabilitation to make informed assessments for postoperative planning. The aim of this study was to identify factors predicting function and rehabilitative needs after intradural spinal tumor surgery. Eighty-five prospectively recruited patients underwent surgery for intradural intramedullary (ID-IM; n = 23) and extramedullary (ID-EM; n = 62) tumors. Neurological and functional status were assessed before surgery, after surgery, and at discharge using the modified McCormick scale (MMS), Karnofsky performance status (KPS) scale, Barthel index (BI), and the gait index (GI). There were no significant predictors of early postoperative rehabilitation in the ID-IM group. In the ID-EM group, age, thoracic level, subtotal resection (STR), repeat surgery, and functional scale scores predicted the need for rehabilitation. In multivariable analysis, MMS (odds ratio (OR) 8.7; 95% confidence interval (CI): 2.37-32.44) and STR (OR 13.00; 95%CI: 1.56-107.87) remained independent predictors of rehabilitation need (area under curve, 92%). Despite their younger age, most patients with ID-IM tumors, especially ependymomas, required rehabilitation but improved quickly (KPS, BI, p < 0.001). Among ID-EM tumors, meningiomas were characterized by poorer preoperative function and low gross total resection (GTR) rates, but did not deteriorate neurologically after surgery. Patients with schwannoma and ID-EM ependymomas achieved the highest GTR rate and had the best function both before and after surgery. These results may be useful for estimating early rehabilitation needs after intradural tumor surgery and counseling patients before surgery about the expected postoperative course.

Full-Endoscopic Resection of a Lumbar Intradural Tumor (Schwannoma): Video Case Report and Description of the Surgical Technique.

Endoscopic spinal surgery has gained increasing popularity over the past 10 years. Its muscle-preserving nature, reduction in postoperative pain, and lower complication rates have contributed to the growing number of surgeons adopting this technique year after year. This same progression has led to the application of the technique in oncological pathology, primarily for separation surgeries and biopsies of extradural lesions. However, reports in the literature on the use of this technique to treat intradural spinal tumors remain scarce. To present a case report of a patient with an intradural lesion, compatible with schwannoma, successfully removed using a fully endoscopic technique. A 46-year-old female patient presented with a long-standing history of low back pain and bilateral leg pain. The pain worsened over the past few months before her initial presentation. She also reported experiencing weakness in her feet and intermittent hypesthesia in her legs. Magnetic resonance imaging (MRI) showed a small intradural extramedullary tumor at the L1 level. Given the patient's young age, the tumor location at the thoracolumbar junction, and the rather small tumor size, a full-endoscopic approach was selected and performed. A step-by-step video of the surgical technique is provided with the manuscript. The current follow-up period is 2.5 years, with the patient remaining asymptomatic. The most recent follow-up MRI, conducted 16 months after the surgery, indicated no signs of recurrence. To our knowledge, this is the first video report providing a step-by-step description of this procedure. More high-quality evidence is needed to properly evaluate the safety and outcomes of this technique.

MANAGEMENT OF EXTRAMEDULLARY INTRADURAL SPINAL TUMORS

Spinal tumors are relatively uncommon, accounting for approximately 5%–10% of all central nervous system tumors, with an estimated 70%–80% being located in the intradural extramedullary space. The most common intradural extramedullary tumors are schwannomas, followed by meningiomas. Other less common intradural extramedullary tumors include myxopapillary ependymomas. The clinical presentation of these tumors is often rather nonspecific, and clinicians must maintain a high index of suspicion when evaluating patients with chronic back pain. Approximately 50% of affected individuals experience nonspecific back pain, whereas radiating pain, motor deficits, and sensory loss often progress gradually. This study examines the surgical management of intradural spinal tumors treated in our department, focusing on surgical techniques Some of these benign lesions can pose a surgical challenge due to their location to spinal cord, tumor consistency (densely mineralized / calcified). Posterior approaches involving laminectomy while preserving facet joints are typically sufficient for the surgical resection of dorsal and dorsolateral tumors. In conclusion the total surgical removal of these tumors while preserving neurological function remains can pose a surgical challenge especially for those that are densely calcifed and situated anterolateral to spinal cord, but employing standard microsurgical techniques often makes these resections possible.

Management of intradural extramedullary and intramedullary spinal tumors

Intradural spine tumors are relatively uncommon and include tumors outside (extramedullary) or within the spinal cord (intramedullary). The proximity of these tumors to important neural structures can cause significant neurologic morbidity and prompt management is critical for maintaining function. Surgical intervention is generally the primary treatment depending on presenting symptoms, radiologic features, and the likelihood of a clear surgical planes vis-à-vis the spinal cord. Adjuvant radiation, chemotherapy, or other novel therapeutic strategies may play a role in postoperative management. Here we review management strategies for common intradural extramedullary (meningiomas, schwannomas, and neurofibromas) and intradural intramedullary tumors (astrocytomas, ependymomas, and hemangioblastomas).

Lumbar Spinal Meningioma- A common tumor in an uncommon location: A case report

Meningioma in the spinal canal commonly appears as intradural extramedullary spinal tumors at the dorsal and cervical region but is rare in the lumbar area. A 36-year-old man presented to us with complaints of left sciatica, weakness, and difficulty in movements of his left toes for a couple of months. Magnetic Resonance Imaging revealed an enhancing oval-shaped lesion at the level of L4, and histopathology revealed a meningioma. The complete removal has been done with hemilaminectomy for this common tumor in an uncommon location. J Shaheed Suhrawardy Med Coll 2023; 15(1): 78-82

Does the presence or absence of preoperative lower extremity neurologic symptoms influence postoperative clinical outcome in patients with cervical intradural extramedullary tumors?: a single-center retrospective comparative study.

Retrospective comparative study OBJECTIVES: To investigate whether the presence or absence of preoperative lower extremities neurological symptoms (LENS) influences clinical outcomes following tumor resection in patients with cervical intradural extramedullary (IDEM) tumors. The single institution in Japan. Ninety-two patients with cervical IDEM tumors requiring surgical resection were included. Based on the degree of preoperative LENS assessed using the modified McCormick scale (MMCS), patients were categorized into LENS (-) and (+) groups. Demographic and surgical characteristics were compared between both groups. There were no significant differences observed in sex, tumor location, tumor size, surgical time, estimated blood loss, approach for tumorectomy, or tumor histopathology between the two groups. Additionally, the overall surgical outcomes were favorable for both groups. At the final follow-up, 91.1% of the patients in the LENS (+) group were able to walk without support. Improvement in LENS was observed after surgery in most patients with preoperative MMCS II-IV, but it persisted in approximately 40% of patients with preoperative MMCS V. In the LENS (+) group, there were no significant differences in demographic or surgical data between the patients with MMCS I and II-III at the final follow-up. Regardless of the presence or absence of preoperative LENS, clinical improvement was observed after tumor resection in most patients with cervical IDEM tumors. These findings suggest that neurological status is likely to improve sufficiently if tumor resection is performed before preoperative LENS deteriorates to an extremely severe stage as MMCS V.

Clinical evaluation of enhanced recovery versus conventional care in the perioperative period for intradural extramedullary spinal tumors: a study protocol for a multicenter, randomized controlled trial

BackgroundThis randomized clinical trial protocol aimed to investigate the comparative efficacy of an enhanced recovery after surgery (ERAS) protocol versus traditional perioperative care programs in patients with intradural extramedullary spinal tumors.MethodsThe study included 180 patients aged 18–80 years, who were randomly assigned to two groups: Group A receiving traditional perioperative care and Group B receiving accelerated rehabilitation perioperative care. The nurse responsible for patient care was informed of the group assignment, but the patients themselves remained blinded to the intervention. The primary outcome measure was the Karnofsky Performance Scale score, which assessed functional status. The secondary outcomes included the Japanese Orthopedic Association Scale, Numeric Pain Rating Scale, length of postoperative hospital stay, duration of urethral catheterization, patient satisfaction questionnaire, and complication rates. Follow-up assessments were conducted telephonically 1 month, 3 months, and 6 months after the surgery.DiscussionThis study protocol provided a structured approach to assess the potential benefits of ERAS during the perioperative period for patients with intradural extramedullary tumors, aiming to improve patient outcomes and overall care efficiency.Trial registrationThis study has been registered with the China Clinical Trials Registry (Project No: ChiCTR2200063347). Registered on September 5 2022.

A Concise Guide to D-Wave Monitoring during Intramedullary Spinal Cord Tumour Surgery.

D-waves (also called direct waves) result from the direct activation of fast-conducting, thickly myelinated corticospinal tract (CST) fibres after a single electrical stimulus. During intraoperative neurophysiological monitoring, D-waves are used to assess the long-term motor outcomes of patients undergoing surgery for intramedullary spinal cord tumours, selected cases of intradural extramedullary tumours and surgery for syringomyelia. In the present manuscript, we discuss D-wave monitoring and its role as a tool for monitoring the CST during spinal cord surgery. We describe the neurophysiological background and provide some recommendations for recording and stimulation, as well as possible future perspectives. Further, we introduce the concept of anti D-wave and present an illustrative case with successful recordings.

Resection and postoperative pazopanib for intraspinal recurrent solitary fibrous tumor: illustrative case.

Intracranial solitary fibrous tumors (SFTs) rarely recur in the spinal space. Only 4 cases of spinal recurrence from intracranial SFT have been reported; therefore, the optimal treatment of recurrent spinal SFT remains unclear. A 53-year-old woman with a history of resection of a right occipital anaplastic SFT presented with progressive back and side pain. She was diagnosed with an intradural extramedullary tumor ventral to the spinal cord at the T5-7 level. She underwent tumor resection with T5-6 laminectomy and T4 and T7 partial laminectomy. The tumor was completely removed in a piecemeal fashion using an ultrasonic aspirator with careful control of bleeding. Her symptoms quickly improved after the surgery, and she returned to normal life. The tumor was diagnosed as SFT. Pazopanib was administered postoperatively. Despite the recurrence of the intracranial tumor, the patient was alive without recurrence of the spinal tumor 14 months after resection. Although rare, intracranial SFTs have a risk of spinal recurrence. Complete resection of a recurrent spinal SFT can be achieved even in the ventral location. Pazopanib could be a possible therapeutic option for preventing local tumor recurrence in the management of recurrent spinal SFT. https://thejns.org/doi/10.3171/CASE24217.

Functional outcome after introduction of hemilaminectomy in management of spinal schwannomas and meningiomas

BackgroundSchwannomas and meningiomas are intradural extramedullary spinal tumors which are regularly encountered in the neurosurgical clinic. These tumors cause neurological deficit by compression on the spinal cord and commonly pain when affecting the cauda equina. The traditional treatment with standard laminectomy (SL) can cause instability to the dorsal segments of the spinal column, and the less invasive option of hemilaminectomy (HL) has therefore been developed. We aim in this study to investigate transition from SL to HL in a population-based cohort. MethodsAdult patients (18 years and older) undergoing primary surgery due to spinal meningioma or schwannoma between 2007 and 2022 at the neurosurgical clinic were included. Data related to clinical, surgical and outcome variables were retrospectively collected. ResultsA total of 187 patients were identified: 155 in the SL group, 26 in the HL group and in 6 patients a combination of SL and HL. The mean age of the SL group was 62.7 years (SD14.2) compared to 58.0 (SD15.7) in the HL group (p = 0.16). Preoperative motor deficit was more common in SL group compared to HL group (76.8 % and 61.5 %, respectively, p = 0.14). Thoracal location was most common for both groups (SL 65.8 % and HL 61.5 %). Postoperative change in McCormick grades and early complications were similar between groups. ConclusionOutcome after hemilaminectomy due to intradural extramedullary schwannoma or meningioma is comparable to standard laminectomy with regards to postoperative complications and neurological improvement. Our findings support the transition to hemilaminectomy in selected cases.

Intradural Melanotic Schwannoma of the Sacral Spine: An Illustrated Case Report of Diagnostic Conundrum

Schwannomas are benign and slow-growing peripheral nerve sheath neoplasms of Schwann cells. These are generally encountered in the neck, head, and flexor areas of the extremities. Even though many schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. In this study, we present a rare case of melanotic schwannoma of the sacrum, emphasizing the need for routine biopsy to understand the etiology. A 46-year-old man presented to the Department of Neurosurgery, Taipei Medical University Hospital, with buttock pain in the sacrum area for 1 year, which worsened in the last 1–2 months. The patient had no known history of trauma or malignancy. We evidenced an intradural extramedullary neurogenic tumor at the caudal end from S1 to S3. Histologic analysis revealed melanin deposition in the tumor cells. Round to oval tumor cells were positive for HMB-45 and S-100 proteins, suggestive of melanotic Schwannoma, which were removed by laminectomy. After 1 month, the tumor recurred and was further removed surgically. Conclusively, we observed the sacrum as an unusual anatomic site for the possible occurrence of melanotic schwannoma, especially in patients with no known history of trauma and malignancy. The possibility of melanotic schwannoma is very high. We hypothesize that melanotic schwannoma was possible because it occurred in the intradural and extramedullary regions of the spine. Hence, a routine biopsy should be performed to corroborate the exact cause and prevent incorrect presumptions.

Identifying functional cortical plasticity after spinal tumour resection using navigated transcranial magnetic stimulation.

Our aim was to investigate the effectiveness of navigated transcranial magnetic stimulation (nTMS) brain mapping to characterise preoperative motor impairment caused by an intradural extramedullary (IDEM) tumour and postoperative cortical functional reorganisation. Preoperative and 1-year follow-up clinical, radiological and nTMS data from a case of thoracic spinal meningioma that underwent surgical resection of the lesion were collected and compared. A 67-year-old patient presented with severe progressive thoracic myelopathy (hypertonic paraparesis, clonus, insensate urinary retention) secondary to an IDEM tumour. Initial nTMS assessment showed bilateral upper limb representation with no positive responses for both lower limbs. He underwent successful surgical resection for his IDEM (meningioma WHO grade 1). At 1-year follow-up, the patient's gait was improved and his bladder function normalised. nTMS documented positive responses for both upper and lower limbs and a decrease in the area (right side: 1.01 vs 0.39cm2; left side: 1.92 vs 0.81cm2) and volume (right side: 344.2 vs 42.4uVcm2; left side: 467.1 vs 119uVcm2) of cortical activation for both upper limbs, suggesting a functional reorganisation of the motor areas after tumour resection. nTMS motor mapping and derived metrics can characterise preoperative motor deficit and cortical plasticity during follow-up after IDEM resection.

Does Minimally Invasive Hemilaminectomy for Intradural Extramedullary Tumor Resection Prevent Postlaminectomy Kyphosis or Lordosis Loss?

Minimally invasive hemilaminectomy is a safe and effective alternative to open laminectomy for treating intradural extramedullary tumors. There are no reports of postoperative kyphosis after this approach. This study aims to determine whether performing minimally invasive spine surgery hemilaminectomy for intradural extramedullary tumors can prevent the development of postlaminectomy kyphosis (PLK) or lordosis loss. Sixty-five patients with spinal intradural extramedullary tumors who underwent minimally invasive hemilaminectomy surgery and complete pre and postoperative radiologic imaging were included. The effect of the surgical approach on the spinal sagittal axis was assessed by comparing pre- versus postoperative segmental and local Cobb angles at different spinal levels, considering anatomical localization (cervical, thoracic, lumbar, and transition segments) and functional features (mobile, semi-rigid, and transition segments), as well as the extent of the surgical approach (1, 2, or 3 levels) and follow-up. None of the patients had an increase in thoracic kyphosis nor a loss of cervical or lumbar lordosis greater than or equal to 10° after undergoing the minimally invasive spine surgery hemilaminectomy approach.More than 5° of increase in kyphosis was detected on 7.4% and 11.1%, for the segmental and the local angles, respectively; meanwhile, for patients with loss of lordosis, this deviation was detected in 5.3%, for both angles. The occurrence of PLK was more common than that of lordosis loss, but mainly manifested in postoperative angle impairment of less than 5°. No significant differences were evidenced, considering theapproach length. Hemilaminectomy represents a promising approach for preventing PLK and postlaminectomy lordosis loss following intradural extramedullary tumor resection.

Epidemiology study on the prognostic factors of intradural extramedullary spinal tumors.

Intradural extramedullary (IDEM) tumors are rare tumors of the spinal cord. Currently, there is no evidence on the factors that predict poor outcomes in the patients. The objective of this study was to determine the prognostic factors that are associated with poor outcomes in IDEM tumors. Patients 18 years and older with IDEM tumors who underwent surgery at our institute were identified and retrospectively reviewed. The patient's demographic data, risk factors, and modified McCormick Scale score were collected. A total of 129 patients with IDEM were included in this study. The age ranged from 19 to 79 years (mean 51.3 years), with a predominantly female population (85 patients, 65.9%). Eighty-nine (68.9%) patients had a good outcome, while 40 (31.0%) patients had a poor outcome. The significant factors for poor outcomes included the number of vertebral levels removed for tumor access (adjusted odds ratio [OR] = 3.80, 95% confidence interval [CI] =1.30-11.08, P = 0.013); pathology other than meningioma, schwannoma, and neurofibroma (adjusted OR = 18.86, 95% CI = 2.16-164.49, P = 0.007); and bowel/bladder involvement (adjusted OR = 3.47, 95% CI = 1.15-10.39, P = 0.027). We found that the factors for poor outcomes included bowel/bladder involvement, number of vertebral levels removed for tumor access, and pathology other than meningioma, schwannoma, and neurofibroma.

SPINAL INTRADURAL EXTRAMEDULLARY TUMORS AND SIMILAR PATHOLOGIES: A SINGLE CENTER STUDY

Background: We wanted to analyze the neurological symptoms and prognosis of five spinal IDEM (intradural extramedullary) tumors cases diagnosed, and to emphasize that a spinal cord tumor can be found incidentally in evoluation of the proximal regions of the vertebral column in patients who were mistakenly operated for lumbar disc herniation on lumbar MRI, but whosesymptoms did not resolve. Objective: To emphasize the need for examinations such as MRI along the vertebral columna in patients with different spinal pathologies and whose symptoms and clinical signs do not improve. Methods: Patients with spinal IDEM tumors treated with surgical excision and followed for more than 2 years were retrospectively analyzed. Issessed pain with the visual analo scale (VAS), and neurological function with the Nurrick grade.Preoperative complaint time,location of tumor in sagital and axial sections in MRI and pathological diagnosis were investigated. Results: The pathological diagnosis in our study was meningioma in two cases,dural arteriovenous fistula in one case,teratoma in one case ,and myxopapilary epandimoma in one case.İn one case,disc herniation surgery was performed in another hospital due to misdiagnosis, but because the patient’s complaints were resistant. In examination, an IDEM tumor at T11 level was detected, and he was operated. In all cases the VAS score (mean) was reduced from 7.8 to 0.4 as well as the Nurrick grade (mean) was from 2.0 to 0.6. In the dAVF case, spasticity in the lower extremities, bladder and bowel disfunction continued. Conclusion: In cases with severe neurological deficits, MRI scanning of the proximal parts of the vertebral column will help in the differential diagnosis of the lesion occupying the intraspinal space.

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India.

Objective Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as "reference standard." Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.

Unilateral hemilaminectomy vs. laminoplasty for the resection of spinal schwannomas: an analysis of 100 patients.

Spinal schwannomas are the most common intradural extramedullary tumors, and their complete removal is recommended to avoid tumor recurrence. Although laminoplasty provides a sufficient window for tumor resection, this approach may increase tissue trauma and cause postoperative instability compared with unilateral hemilaminectomy. This study aimed to compare the efficacy and clinical outcomes of the two approaches. We included 100 consecutive patients who underwent unilateral hemilaminectomy or laminoplasty for resection of spinal schwannomas between January 2015 and February 2023. The patients' baseline characteristics, including sex, age, tumor location, percentage of tumor occupying the intradural space, operative time, postoperative length of hospital stay, intraoperative bleeding volume, visual analog scale score, and neurologic results, were retrospectively analyzed. Hemilaminectomy patients who underwent unilateral hemilaminectomy had smaller intraoperative bleeding (p = 0.020) volume, shorter operative time (p = 0.012), and shorter postoperative length of hospital stay (p = 0.044). The mean VAS scores at the last follow-up were similar between the two groups (p = 0.658). Although the postoperative McCormick and Karnofsky Performance scores were not significantly different between the laminoplasty and unilateral hemilaminectomy groups (p = 0.687 and p = 0.649, respectively), there was a statistically significant improvement based on postoperative neurological results compared to preoperative neurological results for both groups. The incidence of postoperative complications was 5% and 11.7% in the unilateral hemilaminectomy and laminoplasty groups, respectively (p = 0.308). For spinal schwannoma resection, unilateral hemilaminectomy has more advantages than laminoplasty, including a shorter postoperative hospital stay, faster procedure, and less intraoperative blood loss while achieving the same desired result.

Differentiation of the Intradural Extramedullary Spinal Tumors, Schwannomas, and Meningiomas Utilizing the Contrast Ratio as a Quantitative Magnetic Resonance Imaging Method

Schwannomas and meningiomas are the most common intradural extramedullary spinal tumors; however, differentiating between them using magnetic resonance imaging (MRI) is a frequent challenge. In this study, we aimed to investigate the use of the contrast ratio (CR) as a quantitative MRI method in the differentiation of schwannomas and meningiomas. We analyzed the data of patients with intradural extramedullary spinal tumors who underwent surgery and were diagnosed with either schwannomas or meningiomas by histopathological analysis. Regions of interest were set for the entire spinal tumor on T2-weighted sagittal MRI. To obtain the CR values of spinal tumors (CRtumor), we used the signal intensity (SI) values of the tumor (SItumor) and spinal cord (SIcord) according to the following formula: [CRtumor= (SItumor-SIcord)/(SItumor+SIcord)]. The study included 50 patients (23 males and 27 females) with a mean age of 61.5 years old (11-85 years old). Histopathological analysis revealed that 33 and 17 patients were diagnosed with schwannomas and meningiomas, respectively. The mean CR values of the schwannomas and meningiomas were 0.3040±0.1386 and 0.0173±0.1929, respectively. The CR value of the schwannomas was statistically significantly higher than that of meningiomas (P<0.01). The cutoff CR value obtained from the receiver operating characteristic curve was 0.143, with a specificity and sensitivity of 90.9% and 88.2%, respectively. Furthermore, the value for the area under the receiver operating characteristic curve was 0.925 (95% confidence interval: 0.852-0.998). The evaluation of CRs by using MRI to distinguish between schwannomas and meningiomas is a beneficial quantitative tool.