Intradural Spinal Tumors Research Articles

Use of the intraoperative ultrasonography in intradural spinal tumor surgery

To review our experience gained from the use of intraoperative ultrasonography (IOUSG) in intradural spinal tumor surgery. IOUSG was used during surgery of 69 intradural spinal tumors, operated on between 2012 and 2016. A 5-8 MHz probe of IOUSG was used, before and after durotomy to perform the exact durotomy and myelotomy, and after tumor resection, to detect a residual tumor. A retrospective review of parameters including demographic data, localization and histopathology of the tumour, IOUSG findings, and the amount of tumor resection was made. In a total of 69 intradural spinal tumors (42 extramedullary, and 27 intramedullary tumors) IOUSG was used during surgery. Total excision was performed in 68 cases, and subtotal excision in one case. Pre-durotomy IOUSG showed sufficient laminectomy in 62 cases. In 7 cases, as the IOUSG failed to show all borders of the tumor, laminectomy was extended. IOUSG is an important tool, which contributes to intradural spine surgery. This modality shows the tumor appearance before durotomy, and is therefore helpful in deciding the amount of laminectomy and duratomy in addition to the exact location of myelotomy. It also provides the surgeon with information about residual tumor after excision, thereby increasing the safety and success of the surgical procedure.

Effectiveness of intraoperative monitoring of motor evoked potentials for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period

The study aim was to evaluate the effectiveness of intraoperative monitoring of motor evoked potentials (MEPs) for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period. The study included 74 patients with intradural cervical spinal cord tumors who were operated on using motor evoked potential monitoring in the period from 2013 to 2016. There were 29 (39%) males and 46 (61%) females. Group 1 included 26 (35%) patients with intramedullary tumors; group 2 included 48 (65%) patients with intradural extramedullary tumors. The neurological status was assessed by using a six-grade muscle power MRC scale; a modified McCormick scale was used to evaluate the functional status. Transcranial electrical stimulation of the precentral gyri was performed. Recording electrodes were located in the peripheral target muscles of the upper and lower limbs. Total intravenous anesthesia with propofol and fentanyl was used. In Group 1, MEPs decreased in 19 (73%) of 26 patients; MEPs remained unchanged in 7 (27%) patients. Among the patients with decreased MEPs, 14 (74%) patients had postoperative deterioration of the neurological status; 6 (32%) patients had a preoperative severe neurological deficit; 4 (21%) patients had no changes in the neurological status. The sensitivity and specificity of MEPs from the upper limb muscles were higher than those from the lower limb muscles. In Group 2, improvement of the neurological status occurred in all 48 patients. There was no case of a true positive decrease in the MEP amplitude. 1. Registration of MEPs is a highly sensitive and highly specific method for diagnosing corticospinal tract dysfunction in patients with intramedullary tumors of the cervical spinal cord. The sensitivity and specificity of MEPs recorded from the upper limbs are higher than those from the lower limb muscles. 2. The sensitivity of MEPs in patients with extramedullary intradural tumors was 0%, the diagnostic effectiveness of MEPs amounted to 86% from the upper limb muscles and 93% from the lower limb muscles. 3. When the MEP amplitude in patients with extra- and intramedullary tumors of the cervical spinal cord decreases, a change in the surgion's approach may reduce or completely eliminate surgically-induced damage to the spinal cord.

Management of Spinal Schwannomas in Gabriel Touré Hospital: Review of 11 Cases

Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Toure Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study, the clinical manifestations and surgical results of 11 cases of spinal schwannoma have been reviewed. Early diagnosis and appropriate treatment are essential for good outcome.

Clinicopathological Study of Patients with Intradural Extramedullary Spinal Tumours and Surgical Outcome

Clinicopathological Study of Patients with Intradural Extramedullary Spinal Tumours and Surgical Outcome

Surgical Outcome of Spinal Intradural Extramedullary Tumors: A Single-center Prospective Study of 92 Cases—Assessment using Nurick\'s Grade and Visual Analog Scale

Surgical Outcome of Spinal Intradural Extramedullary Tumors: A Single-center Prospective Study of 92 Cases—Assessment using Nurick\'s Grade and Visual Analog Scale

Sporadic hemangioblastoma of the film terminale with peritumoral cyst

Background:Spinal hemangioblastoma originating from the film terminale are rare tumors. Here, we present a film terminale hemangioblastoma and review the appropriate literature.Case Description:A 37-year-old female presented with bilateral lower extremity pain without a focal neurological deficit. The magnetic resonance (MR) image demonstrated an intradural spinal tumor at the L1 level, which was accompanied by peritumoral cysts. In addition, there were multiple surpentine flow voids (e.g., consistent with torturous and convoluted vessels), which is typical for hemangioblastoma. At surgery, a spinal hemangioblastoma originating from the film terminale with peritumoral cysts at the L1 level was fully excised without producing a focal postoperative neurological deficit. Histological examination revealed stromal cells with vacuolated cytoplasm and small nuclei in a rich capillary network accompanied by several enlarged vessels. These finding were compatible with a hemangioblastoma.Conclusions:We reported a rare case of a hemangioblastoma originating from the conus presenting at the L1 level. Complete surgical resection was accomplished without any motor deficit.

Recent advances in intradural spinal tumors.

Intradural spinal tumors are rare tumors of the central nervous system. Due to the eloquence of the spinal cord and its tracts, the compact architecture of the cord and nerves, and the infiltrative nature of some of these tumors, surgical resection is difficult to achieve without causing neurological deficits. Likewise, chemotherapy and radiotherapy are utilized more cautiously in the treatment of intradural spinal tumors than their cranial counterparts. Targeted therapies aimed at the genetic alterations and molecular biology tailored to these tumors would be helpful but are lacking.Here, we review the major types of intradural spinal tumors, with an emphasis on genetic alterations, molecular biology, and experimental therapies for these difficult to treat neoplasms.

268 - Predictors of Discharge Destination following Elective Laminectomy for Excision of Intradural Extramedullary Spinal Tumors

268 - Predictors of Discharge Destination following Elective Laminectomy for Excision of Intradural Extramedullary Spinal Tumors

267 - High ASA Classification Is a Risk Factor for Short-Term Adverse Outcomes following Laminectomy for Removal of Intradural Extramedullary Spinal Tumors

267 - High ASA Classification Is a Risk Factor for Short-Term Adverse Outcomes following Laminectomy for Removal of Intradural Extramedullary Spinal Tumors

Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors.

Healthcare resource utilization and patient-reported outcomes (PROs) for intradural extramedullary (IDEM) spine tumors are not well reported. To analyze the PROs, costs, and resource utilization 1 year following surgical resection of IDEM tumors. Patients undergoing elective spine surgery for IDEM tumors and enrolled in a single-center, prospective, longitudinal registry were analyzed. Baseline and postoperative 1-year PROs were recorded. One-year spine-related direct and indirect healthcare resource utilization was assessed. One-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). A total of 38 IDEM tumor patients were included in this analysis. There was significant improvement in quality of life (EuroQol-5D), disability (Oswestry and Neck Disability Indices), pain (Numeric rating scale pain scores for back/neck pain and leg/arm pain), and general physical and mental health (Short-form-12 health survey, physical and mental component scores) in both groups 1 year after surgery (P < .0001). Eighty-seven percent (n = 33) of patients were satisfied with surgery. The 1-year postdischarge resource utilization including healthcare visits, medication, and diagnostic cost was $4111 ± $3596. The mean total direct cost was $23 717 ± $7412 and indirect cost was $5544 ± $4336, resulting in total 1-year cost $29 177 ± $9314. Surgical resection of the IDEM provides improvement in patient-reported quality of life, disability, pain, general health, and satisfaction at 1 year following surgery. Furthermore, we report the granular costs of surgical resection and healthcare resource utilization in this population.

Neurosurgical Outcomes of Intradural Extramedullary Spinal Tumors in 97 cases:Siberian Experience

We retrospectively investigated the clinical presentation and outcome of patients with spinal intradural extramedullary tumors, which had been surgically treated. A total of 97 consecutive patients(32 males and 65 females;mean age, 48 years;range, 17-79 years)underwent surgery between 2004 and 2014 at Irkutsk State Medical Academy and affiliated hospitals. To determine presentation and outcomes associated with these tumors, we evaluated the waiting period before surgery, neurological symptoms including motor, sensory, urinary, and rectal dysfunction, modified McCormick scale, Macnab's outcome assessment of patient satisfaction, surgical procedure, tumor location, and histological diagnosis. The most frequent preoperative symptom was myelopathy(52.6%)at presentation, followed by radiculopathy(20.6%), and a combination of both(26.8%). Surgical intervention produced highly successful results, in which 77 of 97 cases showed neurological improvement. However, the symptoms were not completely reversed, and there was improvement only the equivalent to one grade in the modified McCormick scale for most patients. Surgical outcomes were not influenced by tumor location, extent of lamina resection, or histological diagnosis, but there was a correlation between greater patient improvement and a shorter waiting period before surgery. As such, we recommend early total resection for symptomatic spinal intradural extramedullary tumors.

A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature

BackgroundSpinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia.Case presentationA 67-year-old female presented with a low back pain and left sciatica. Although the patient had experienced occasional mild low back pain for several years, her low back pain markedly worsened 2 months before her visit, as well as newly developed left sciatica resulting in intermittent claudication. She had a history of several abdominal surgeries. All abdominal procedures were performed under general anesthesia with epidural anesthesia in her thoracolumbar spine. Magnetic resonance imaging of her lumbar spine demonstrated an intradural extramedullary spinal cord tumor at the T12–L1 level. Because her symptoms deteriorated, the tumor excision was performed using microscopy. Histological examination of the specimens demonstrated that the cyst walls lined with stratified squamous keratinizing epithelium surrounded by the outer layer of collagenous tissue with the absence of skin adnexa. A diagnosis of epidermoid cysts was confirmed. Her MRI showed complete resection of the tumor, and there was no recurrence at 2-year follow-up.ConclusionsIn this case report, epidermoid cells might be contaminated into the spinal canal during repetitive epidural anesthesia. The patient was successfully treated by complete resection, and there was no recurrence at 2-year follow-up with a good clinical outcome. However, long-term follow-up is required for a potential risk of tumor recurrence.

Analysis of Patients with Myelopathy due to Benign Intradural Spinal Tumors with Concomitant Lumbar Degenerative Diseases Misdiagnosed and Erroneously Treated with Lumbar Surgery.

When a cervical or thoracic benign intradural spinal tumor (BIST) coexists with lumbar degenerative diseases (LDD), diagnosis can be difficult. Symptoms of BIST-myelopathy can be mistaken as being related to LDD. Worse, an unnecessary lumbar surgery could be performed. This study was conducted to analyze cases in which an erroneous lumbar surgery was undertaken in the wake of failure to identify BIST-associated myelopathy. Cases were found in a hospital database. Patients who underwent surgery for LDD first and then another surgery for BIST removal within a short interval were studied. Issues investigated included why the BISTs were missed, how they were found later, and how the patients reacted to the unnecessary lumbar procedures. Over 10 years, 167 patients received both surgeries for LDD and a cervical or thoracic BIST. In 7 patients, lumbar surgery preceded tumor removal by a short interval. Mistakes shared by the physicians included failure to detect myelopathy and a BIST, and a hasty decision for lumbar surgery, which soon turned out to be futile. Although the BISTs were subsequently found and removed, 5 patients believed that the lumbar surgery was unnecessary, with 4 patients expressing regrets and 1 patient threatening to take legal action against the initial surgeon. Concomitant symptomatic LDD and BIST-associated myelopathy pose a diagnostic challenge. Spine specialists should refrain from reflexively linking leg symptoms and impaired ability to walk to LDD. Comprehensive patient evaluation is fundamental to avoid misdiagnosis and wrong lumbar surgery.

Capillary Hemangioma of Thoracic Spinal Cord

Capillary hemangiomas are frequently encountered superficially in the cutaneous, subcutaneous, or mucosal tissues during the childhood and early adulthood, but the occurrence of spinal intradural capillary hemangioma is relatively rare. Herein, we report a case with capillary hemangioma of the thoracic spine. MR and PET/CT features of this lesion are presented, and awareness of this entity may help differentiate it from other spinal intradural tumors.

Review of stereotactic radiosurgery for intradural spine tumors.

Stereotactic radiosurgery (SRS) has become an increasingly popular treatment modality for spinal tumors due to its noninvasive and targeted approach. Whether SRS has the promise of relieving pretreatment symptoms and providing local tumor control for patients with intradural spine tumors is still debated. This review explores the current literature on SRS treatment for both metastatic and benign intradural tumors, with a focus on differential use for intramedullary and intradural extramedullary neoplasms. Although mortality rates from underlying malignant disease remain high, SRS may benefit patients with spinal metastatic lesions. Benign tumors have shown a promising response to SRS therapy with low rates of complications. Larger studies are necessary to determine the indications and outcome profile of SRS for intradural spinal neoplasms.

In reply to the letter to the editor regarding “Intraoperative neurophysiologic monitoring in spinal intradural extramedullary tumors: only a prognostic tool?”

In reply to the letter to the editor regarding “Intraoperative neurophysiologic monitoring in spinal intradural extramedullary tumors: only a prognostic tool?”

Intraoperative neurophysiologic monitoring in spinal intradural extramedullary tumors: only a prognostic tool?

Intraoperative neurophysiologic monitoring in spinal intradural extramedullary tumors: only a prognostic tool?

İhmal edilmiş bir dev servikal intradural extramedüller tümör

Primary spinal tumors are rarely seen, and representing 4-8% of all central nervous system tumors. Extradural tumors constitute approximately 40% of intraspinal tumors whereas intradural-extramedullary tumors make up the remaining approximately 60%. These tumors are classified as extradural, intradural, extramedullary, and intramedullary depending on their origin and anatomic location. Intradural extramedullary spinal tumors form schwannomas and meningiomas. Spinal meningiomas are usually intradural extramedullary tumors. Meningiomas can be seen in epidural localization, extradural extension only, with nerve rostral invasion as, vertebral meningioma, or as multiple spinal meningioma. Spinal meningiomas are the most common intradural-extramedullary tumors and are generally slow-growing. Spinal meningiomas may have different clinical manifestations depending on their location and size. Surgical treatment should be planned according to the size of the tumor in the clinical situation after diagnosis. This study reports the case of a 57-year-old female patient presenting with a one-month history of increasing weakness in the lower extremities and numbness in the upper extremities. In addition, the report includes a literature review.

Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome

Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic monitoring (IONM) in order to minimize neurological injury, but the evidence for the statistical efficacy of this utility is lacking. This paper evaluates IONM benefits in IDEM tumor resection. Data of patients treated surgically for spinal intradural tumors from 1998 to 2003 was previously collected and analyzed. We retrospectively evaluated patients' charts operated in the years 2011 to 2013. Patients' medical files were reviewed including radiological examinations and electrophysiological reports. The data was collected and evaluated. Forty-one cases of meningioma or nerve sheath tumor resection surgery were performed in the study period. The surgical results were compared to 70 cases of historical controls. Demographic data was similar in these two groups. Sensitivity, specificity, and positive and negative predicted values of IONM were 75, 100, 100, and 97%, respectively. New neurological deficit rate was evident in 10 and 14% for the study and control groups, respectively (not significant). While IONM predicts neurological deficits with high accuracy level, this study does not suggest that there is a significant global benefit of IONM in these cases. As reported by others, in this series, the rate of new neurological deficits in non-monitored cases is similar to the monitored cases series; hence, IONM role in preventing new neurological deficits has yet to be proven.

Descriptive analysis of unplanned readmission and reoperation rates after intradural spinal tumor resection

IntroductionSpinal cord tumors (SCT) are relatively uncommon and usually require surgical treatment. Readmission within 30days after discharge is an important indicator of health care quality. The aim of this study was to investigate the rates and causes of unplanned readmissions and reoperations after SCT surgery. MethodsA retrospective analysis of patients’ charts at a single center from May 2007 to September 2015 was completed. Inclusion criteria: history of laminectomy with excision of neoplasm in the spinal cord. Exclusion criteria: (1) surgery outside the timeframe; (2) less than 19years old; (3) non-neoplastic intramural pathologies; (4) previous resection at the same location; (5) metastatic lesions. ResultsWe found 131 patients that met criteria. Six patients (4.5%) were readmitted within 30days and two within 90days (1.5%). Four underwent reoperation: one for a cerebrospinal fluid leak, two for pseudomenigoceles, and one for repeat laminectomy. Resection of intramedullary tumors resulted in twice the risk of having one or more complications compared to extramedullary tumors (RR 2.0; 95% CI: 1.0–4.2; p=0.057), and nearly four times the risk of having a neurological complication (RR 3.8; 95% CI 1.5–9.5; p=0.005). ConclusionThis study analyzes readmission, reoperation and complication rates for the surgical care of SCT highlighting how SCT surgery is still involved with morbidity in experienced and specialized centers. This information is useful both for health care enhancement projects and for evidence-based patient counseling.