Intradural Extramedullary Spinal Tumors Research Articles

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 using 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 in distinguishing between schwannomas and meningiomas is a beneficial quantitative tool.

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.

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.

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.

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

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

Surgical resection of an intradural extramedullary spinal tumor.

Large ventrally located spinal meningiomas are typically resected via a posterolateral or lateral approach. Optimal outcomes are associated with good preoperative functional status (i.e., modified McCormick grade < 4), while recurrence rates may be predicted by degree and quality of resection (i.e., low Simpson grade). This video describes the operative techniques for resection of a large ventral C2 intradural extramedullary meningioma in a 71-year-old male presenting with hemibody sensory loss and abnormal gait. A paramedian approach was performed, allowing for adequate exposure and gross-total resection. The patient was discharged on postoperative day 2 and showed near-complete resolution of sensory deficits.

Tandem resection of multiple spinal schwannomas.

This video depicts the resection of three separate intradural extramedullary spinal tumors performed under the same anesthetic. Neuromonitoring was used to identify motor nerve roots, and laminoplasty was performed at the thoracolumbar junction to preserve alignment and minimize the risk of postoperative CSF leak.

Does the degree of preoperative gait disturbance remain after tumor resection in patients with intradural extramedullary spinal cord tumors?

Retrospective comparative study. This study aimed to determine whether the degree of preoperative gait disturbance remains following surgical resection in patients with intradural extramedullary spinal cord tumors (IDEMSCTs), and to investigate any factors that may influence poor improvement in postoperative gait disturbance. The single institution in Japan. In total, 78 IDEMSCTs patients who required surgical excision between 2010 and 2019 were included. According to the degree of preoperative gait disturbance using modified McCormick scale (MMCS) grade, they were divided into the Mild and Severe groups. The mean postoperative follow-up period was 50.7 ± 17.9 months. Data on demographic and surgical characteristics were compared between the two groups. There was no significant difference in terms of age at surgery, sex, tumor size, surgical time, estimated blood loss, tumor histopathology, and postoperative follow-up period between the Mild and Severe groups. At the final follow-up, 84.6% of IDEMSCTs patients were able to walk without support. Gait disturbance improved after surgery in most of the patients with preoperative MMCS grades II-IV, but remained in approximately half of patients with preoperative MMCS grade V. Age at surgery was correlated with poor improvement in postoperative gait disturbance in the Severe group. Regardless of the degree of preoperative gait disturbance, it improved after tumor resection in most of the IDEMSCTs patients. However, in the preoperative MMCS grade III-V cases, older age at surgery would be an important factor associated with poor improvement in postoperative gait disturbance.

Impact of Preoperative Motor Status for the Positive Predictive Value of Transcranial Motor-Evoked Potentials Alerts in Thoracic Spine Surgery: A Prospective Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.

Prospective multicenter study. To investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in thoracic spine surgery and evaluate the impact of specific factors associated with positive predictive value (PPV). One thousand hundred and fifty-six cases of thoracic spine surgeries were examined by comparing patient backgrounds, disease type, preoperative motor status, and Tc-MEP alert timing. Tc-MEP alerts were defined as an amplitude decrease of more than 70% from the baseline waveform. Factors were compared according to preoperative motor status and the result of Tc-MEP alerts. Factors that showed significant differences were identified by univariate and multivariate analysis. Overall sensitivity was 91.9% and specificity was 88.4%. The PPV was significantly higher in the preoperative motor deficits group than in the preoperative no-motor deficits group for both high-risk (60.3% vs 38.3%) and non-high-risk surgery groups (35.1% vs 12.8%). In multivariate logistic analysis, the significant factors associated with true positive were surgical maneuvers related to ossification of the posterior longitudinal ligament (odds ratio = 11.88; 95% CI: 3.17-44.55), resection of intradural intramedullary spinal cord tumor (odds ratio = 8.83; 95% CI: 2.89-27), preoperative motor deficit (odds ratio = 3.46; 95% CI: 1.64-7.3) and resection of intradural extramedullary spinal cord tumor (odds ratio = 3.0; 95% CI: 1.16-7.8). The significant factor associated with false positive was non-attributable alerts (odds ratio = .28; 95% CI: .09-.85). Surgeons are strongly encouraged to use Tc-MEP in patients with preoperative motor deficits, regardless of whether they are undergoing high-risk spine surgery or not. Knowledge of PPV characteristics will greatly assist in effective Tc-MEP enforcement and minimize neurological complications with appropriate interventions.

Spinal intradural extramedullary tumors: microscopic keyhole resection with the focus on intraoperative neurophysiological monitoring and long-term outcome

ObjectiveSpinal schwannomas (SS) and spinal meningiomas (SM) account for most intradural extramedullary (IDEM) tumors. These tumors are usually benign lesions, which generally respond favorably to surgical excision. Few studies up to now tried to determine the long-term outcome after minimally invasive surgery (MIS) with multimodal intraoperative neurophysiological monitoring (IONM) for IDEM tumors. The aim of this study was to present one of the largest case series with special regard to IONM findings and long-term outcome after MIS-keyhole surgery with a tubular retractor system.MethodsBetween January 2013 and August 2018, 87 patients with IDEM tumors who underwent tumor removal surgery via MIS-keyhole approach under multimodal IONM were retrospectively reviewed. The neurological status was assessed using a modified McCormick grading scale pre- and postoperatively. Multimodal IONM consisted of motor evoked potentials (MEP), somatosensory evoked potentials (SEP), and electromyography (EMG). Both short-term and long-term clinical evaluations as well as patients’ medical files were retrospectively analyzed.ResultsSurgeries were performed for resection of SS in 49 patients and SM in 38 patients. Tumor locations were cervical in 16.1%, thoracic in 48.3%, thoracolumbar in 4.6%, lumbar 31%. Critical IONM changes were detected in 9 operations (10.3%) in which there were 2 SEPs, 5 MEPs, and 2 EMG events. Three IONM changes (2 MEPs, 1 EMG) were turned out to be transient change in nature since they were resolved in a short time when immediate corrective actions were initiated. Six patients with permanent IONM changes (2SEPs, 3MEPs, 1EMG event), all deficits had resolved during hospitalization or on short -term follow-up evaluation. Sensitivity, specificity, and positive and negative predicted values of IONM were 100, 96, 67, and 100%, respectively. Gross total resection rate was 100%, and a stable or improved McCormick grade exhibited in all patients. No tumor recurrence and no spinal instability were found in the long-term follow-up evaluation (mean 5.2 ± 2.9 years postoperatively). Overall, 94% of patients were either satisfied or very satisfied with their operation, and 93% patients reported excellent or good general clinical outcome according to Odom’s criteria.ConclusionMIS-keyhole surgery with multimodal IONM for IDEM tumors enables a high level of satisfaction and a satisfying long-term clinical and surgical outcome.

Intradural Extramedullary Tumors and Associated Syndromes.

Most intradural tumors are located within the intradural extramedullary compartment, and the most common tumors are schwannomas and meningiomas. Other less common neoplasms include neurofibroma, solitary fibrous tumor, myxopapillary ependymoma, lymphoma, metastatic leptomeningeal disease, malignant peripheral nerve sheath tumor, and paraganglioma. Patients usually present with gait ataxia, radicular pain, and motor and sensory deficits due to chronic compressive myelopathy or radiculopathy. MRI is the modality of choice for detecting and evaluating intradural extramedullary spinal tumors. This imaging technique helps narrow the differential diagnosis and therefore decide treatment.

Is There a Role for Intraoperative Neuromonitoring in Intradural Extramedullary Spine Tumors? Results and Indications from an Institutional Series.

While intraoperative neurophysiological monitoring (IONM) is considered a standard for intramedullary spinal cord tumor surgery, the effective role of IONM in intradural extramedullary (IDEM) tumors is still debated. We present the results of 60 patients affected by IDEM tumors undergoing surgery with the aid of IONM. Each patient was evaluated according to the modified McCormick scale (MMS) at admission, discharge and at follow-up. During surgery, motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) were studied using the Medtronic NIM-eclipse® 32-channel system (Medtronic Xomed, Inc. 6743 Southpoint Drive North Jacksonville FL USA). Patients' age, gender and tumor location did not affect MMS modifications. Tumors involving more than three levels had an increased likelihood of MMS worsening, while meningioma pathology was associated with worse preoperative and 1-year follow-up MMS. No MEP amplitude ratio was able to predict clinical variations, while intraoperative SEP worsening was associated with 100% risk of poor MMS at discharge and with 50% risk of poor MMS at long-term follow-up. In our opinion, SEP monitoring is a valid tool that may contribute to the preservation of the patient's neurological status. MEP monitoring is not mandatory in IDEM surgery while more studies are required to explore the feasibility and the role of D-wave in this kind of surgery.

Rare case of multiple neurofibromas of the scalp and trunk in association with intradural extramedullary spinal tumor: a case report.

A 63-year-old male from Saptari, Nepal, with multiple insidious swellings in the scalp and trunk region, presented with complaints of weakness of the bilateral lower limb for 6-7 years resulting in difficulties in walking and bleeding from the most significant swelling that was in the occipital area. Masses were present all over the scalp, averaging about 4×4cm, with active bleeding from the two swellings. The authors performed the neurological assessment and histopathological and radiological investigations. A confirmed diagnosis of neurofibroma was made with myelography revealing an intradural extramedullary spinal tumor. A laminectomy with total excision of the tumor was performed. Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) can both develop in the intradural extramedullary spinal compartment. Contrast-enhanced MRI is the most sensitive and specific imaging modality to evaluate possible spinal column lesions. Surgical excision, partial or complete, is the hallmark treatment of neurofibroma.

666 Comparison of Minimally Invasive and Open Surgical Approaches for Intradural-Extramedullary Spine Tumors: A Systematic Review and Meta-Analysis

INTRODUCTION: Traditionally spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery. Removal of these tumors involves significant tissue damage, prolonged recovery, and risk of infection. More recent minimally invasive surgery (MIS) techniques aim to reduce these risks and complications while achieving similar goals of surgery as traditional approaches. METHODS: A systematic literature search was employed (PROSPERO#CRD42022302574) with searches through PubMed (MEDLINE), EBSCO, and Wiley Cochrane Library databases from conception till 9th January 2022. Cohort and case series studies with comparisons of minimally-invasive and open surgery for ID-EM spinal tumors were included; pooled sampled data were included in the random-effects (Mantel-Haenszel method) model for meta-analysis. RESULTS: Our search strategy yielded 403 total articles across these databases – after systematic review and exclusion, 13 studies were included for qualitative and quantitative analysis. On meta-analysis, minimally-invasive approaches were non-inferior to open surgery for achieving gross total resection (RR = 1.01, 95% CI 0.94 – 1.09, p = 0.78, I2 = 0%). Intraoperative blood loss (MD = -119.18, 95% CI -157.83 - -80.52, p &lt; 0.0001, I2 = 89%), operative time (MD = -25.94, 95% CI -50.28 – -1.60, p = 0.04, I2 = 91%), and length of stay (MD=-2.50, 95% CI -3.89 – -1.10, p = 0.0004, I2 = 95%) were significantly lower within cohorts undergoing MIS surgery for ID-EM spinal tumor. CONCLUSIONS: Data within the reviewed studies suggest similar rates of gross total resection within MIS and open surgery cohorts for ID-EM spinal tumors. Moreover, MIS affords shorter hospital stays, decreased blood loss, and operative time for patients. For certain patient groups, MIS spinal tumor resection can be preferred over standard surgical approaches, with preservation of function and decreasing overall surgical complications.

Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors.

Minimally invasive spinal surgery (MISS) for intradural extramedullary (IDEM) spinal tumors is a safe and effective surgical strategy. Currently, various tubular retractors are widely used in the MISS of IDEM spinal tumors, primarily relying on microscopic visualization. To the best of the authors' knowledge, there is no report of pure endoscopic surgery with parallel non-expandable tubular retractors for IDEM spinal lesions. The present study reports a case series of IDEM spinal tumors that were treated via pure endoscopic MISS with a parallel non-expandable tubular retractor. The extent of tumor resection was evaluated by comparing preoperative and postoperative magnetic resonance imaging (MRI). The initial and follow-up clinical conditions were assessed according to the visual analog scale for pain and the modified McCormick scale for neurological status. Postoperative MRI demonstrated that all cases had achieved a gross total resection. After the operation, the clinical symptoms of all patients were significantly improved and there were no serious postoperative complications. At the initial follow-up, the pain experienced by the patients was significantly reduced or had even disappeared, and the neurological deficit was improved by at least one grade on the modified McCormick scale. The present report indicates that pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.

MRI Evaluation of Intradural Extramedullary Spinal Tumors with Histopathological Correlation - A Cross Sectional Study

Introduction: Tumors of nerve sheath, neurofibroma and schwannoma represent 30% of intradural extramedullary tumors. Schwannomas and neurofibromas are histologically composed of Schwann cells. Schwannomas almost always arise from the dorsal sensory roots and form well- encapsulated firm masses that compress adjacent tissue, without invading the involved nerve. Neurofibromas are more complex and are composed of Schwann cells mixed with fibroblast they involve the parent nerve. Meningiomas comprise approximately 25% of primary intraspinal tumors and are second only to nerve sheath tumors in frequency. Spinal cord meningiomas are originate from meningothelial cells near the distal root ganglia. Most menongiomas are intradural extramedullary, only 5% are extradural. Aim of the Study: The aim of this study was to evaluate the role of MRI in diagnosis of intradural extramedullary spinal tumors compared to histopathological findings. Methods: This was a cross sectional study and was conducted in the Department of Radiology and Imaging, Sylhet M.A.G. Osmani Medical College, Sylhet in collaboration with Department of Neurosurgery &amp; Pathology of the same hospital, Sylhet, Bangladesh during the period from September, 2018 to August 2020. Result: In total 35 patients completed the study. In our study we found the Mean ± SD of age was 41.71±13.9 in years. Majority (54%) of our patients presented with spinal tumor were male compared to female (46%).We found schwannoma was diagnosed by (42.9%), meningioma (31.4%), neurofibroma (25.7%) respectively. Neurofibroma &amp; schwannoma showed male predominance with 66.67% &amp; 60% while meningioma showed female predominance with 63.6%. We found majority (55.6%, 60% &amp; 72.7%) of neurofibroma, schwannoma &amp; meningioma was in dorsal region respectively. Conclusion: In our study we found that MRI is a very sensitive and effective imaging procedure of suspected spinal schwannoma tumor of the spinal cord for accurate pre-operative diagnosis and ........