Intradural Extramedullary Spinal Tumors Research Articles

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

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.

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.

Two cases of hydrocephalus and associated disorders of consciousness in patients with intradural extramedullary spinal tumor

Two cases of hydrocephalus and associated disorders of consciousness in patients with intradural extramedullary spinal tumor

Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient Reported Outcomes and Minimum Clinically Important Difference.

Analysis of prospectively collected longitudinal web-based registry data. To determine relative validity, responsiveness, and minimum clinically important difference (MCID) thresholds in patients undergoing surgery for intradural extramedullary (IDEM) spinal tumors. Patient-reported outcomes (PROs) are vital in establishing the value of care in spinal pathology. There is limited availability of prospective, quality studies reporting PROs for IDEM spine tumors. . A total of 40 patients were analyzed. Baseline, postoperative 3-month, and 12-month PROs were recorded: Oswestry Disability Index or Neck disability Index (ODI/NDI), Quality of life EuroQol-5D (EQ-5D), Short Form-12 (SF-12), Numeric Rating Scale (NRS)-pain scores. Responders were defined as those who achieved a level of improvement one or two, after surgery, on health transition index (HTI) of SF-36. Receiver-operating characteristic curves were generated to assess the validity of PROs, and the difference between standardized response means (SRMs) in responders versus nonresponders was utilized to determine the relative responsiveness of each PRO measure. MCID thresholds were derived using previously reported minimal detectable change approach. A significant improvement across all PROs at 3-months and 12-months follow up was noted. The derived MCID thresholds were 13.9 points: ODI/NDI, 0.14 quality adjusted life years: EQ-5D, 2.8 points: SF-12PCS and 10.7 points: SF-12MCS, 1.9 points: NRS-back/neck pain, and 1.8 points: NRS-leg/arm pain. SF-12PCS was most accurate discriminator of meaningful improvement (area under the curve, AUC-0.83) and most responsive (SRM-1.36) to postoperative improvement. EQ-5D, ODI/NDI, NRS-pain scores were all accurate discriminator (AUC-0.7-0.8) and responsive measures (0.97-0.67) of meaningful postoperative improvement. SF-12MCS was neither a valid discriminator (AUC-0.48) nor a responsive measure (SRM: -1.5) of outcome. Surgical resection of IDEM spinal tumors provides significant and sustained improvement in quality of life, general health, disability, and pain at 12-month after surgery. The surgically resected IDEM-specific clinically meaningful thresholds are reported. All the PROs reported in this study can accurately discriminate responders and nonresponder based on SF-36 HTI index except for SF-12 MCS. 3.

Functional Outcome of Intradural Extramedullary Spinal Tumors after Surgical Resection

Intradural extramedullary (IDEM) spinal tumors account about 40% of all intraspinal tumors and mainly represented by nerve sheath tumors and meningiomas. These two tumors represent about 55% of IDEM tumors and other rare tumors are dermoid, epidermoid, lipomas, metastatic tumors, paragangliomas etc.Technical advances in imaging techniques, MRI and surgical procedures have brought about excellent clinical results of IDEM tumors after surgery in last two decades. However, a small percentage of patients still present poor postoperative neurological outcome due to delayed in diagnosis and surgical intervention, severity of preoperative neurological defi cits and adverse pathology.The aim of this study is to analyze and discuss about the surgical outcome of 65 IDEM tumors operated in twelve years’ period.This is a retrospective study of 65 patients who were operated for IDEM tumors, between 1999 and 2012 in Department of Neurosurgery. One patient who had IDEM arteriovenous malformation was excluded from the study.Neurological outcome was scaled by McCormick’s grading. Follow up period ranged for 5 years to 17 years.After the clinical evaluation, all the patients suspected of having spinal tumors were subjected for MRI with Gadolinium enhancement of presumed level of spine based on neurological findings. Total excision of all IDEM tumors was performed using operating microscope. No intraoperative neurophysiological monitoring was used.There were 40 male and 25 female and age ranged from 10 to 80 years. Most common IDEM tumors were nerve sheath tumors (44), meningiomas (13), hydatid cyst (2), dermoid/epidermoid (2), arachnoid cyst (2) and n were thoracic, cervical and lumbar spines.Total tumor excision was performed in all cases. Post operative Complications rate was 12.3% (7) and common complications included were CSF Leak (5), wound infection (2), meningitis (1).There was no surgery related mortality. Postoperatively 60 patients had improved neurological status, 5 patients had stable neurology. There was no postoperative neurological deterioration.On followed up period 2 patients showed features of recurrence of tumor in 5 years’ period and underwent resurgical treatment. Those two patients with recurrent tumors were nerve sheath tumors.Majority of IDEM tumors are benign and total cure is possible in almost all cases if tumor is excised totally. Excellent neurological recovery has been observed in more than 95% of cases.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 73-80

Letter to the Editor: Intradural extramedullary spinal tumor resection and quality of life.

Letter to the Editor: Intradural extramedullary spinal tumor resection and quality of life.

217 - Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient-Reported Outcomes and Minimum Clinically Important Difference

Study design Analysis of prospectively collected longitudinal web-based registry data. Objective To determine relative validity, responsiveness, and minimum clinically important difference (MCID) thresholds in patients undergoing surgery for intradural extramedullary (IDEM) spinal tumors. Summary of background data Patient-reported outcomes (PROs) are vital in establishing the value of care in spinal pathology. There is limited availability of prospective, quality studies reporting PROs for IDEM spine tumors. Methods . A total of 40 patients were analyzed. Baseline, postoperative 3-month, and 12-month PROs were recorded: Oswestry Disability Index or Neck disability Index (ODI/NDI), Quality of life EuroQol-5D (EQ-5D), Short Form-12 (SF-12), Numeric Rating Scale (NRS)-pain scores. Responders were defined as those who achieved a level of improvement one or two, after surgery, on health transition index (HTI) of SF-36. Receiver-operating characteristic curves were generated to assess the validity of PROs, and the difference between standardized response means (SRMs) in responders versus nonresponders was utilized to determine the relative responsiveness of each PRO measure. MCID thresholds were derived using previously reported minimal detectable change approach. Results A significant improvement across all PROs at 3-months and 12-months follow up was noted. The derived MCID thresholds were 13.9 points: ODI/NDI, 0.14 quality adjusted life years: EQ-5D, 2.8 points: SF-12PCS and 10.7 points: SF-12MCS, 1.9 points: NRS-back/neck pain, and 1.8 points: NRS-leg/arm pain. SF-12PCS was most accurate discriminator of meaningful improvement (area under the curve, AUC-0.83) and most responsive (SRM-1.36) to postoperative improvement. EQ-5D, ODI/NDI, NRS-pain scores were all accurate discriminator (AUC-0.7-0.8) and responsive measures (0.97-0.67) of meaningful postoperative improvement. SF-12MCS was neither a valid discriminator (AUC-0.48) nor a responsive measure (SRM: -1.5) of outcome. Conclusion Surgical resection of IDEM spinal tumors provides significant and sustained improvement in quality of life, general health, disability, and pain at 12-month after surgery. The surgically resected IDEM-specific clinically meaningful thresholds are reported. All the PROs reported in this study can accurately discriminate responders and nonresponder based on SF-36 HTI index except for SF-12 MCS. Level of evidence 3.

216 - Health Care Resource Utilization and Patient-Reported Outcomes following Elective Surgery for Intradural Extramedullary Spinal Tumors

216 - Health Care Resource Utilization and Patient-Reported Outcomes following Elective Surgery for Intradural Extramedullary Spinal Tumors

Surgical management of ventrally located spinal meningiomas via posterior approach.

Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult. Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3years (47-88years). The average observation period was 55.4months (22-132months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence. Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11years after an operation involving a Simpson grade II resection CONCLUSION: Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.

Intradural extramedullary spinal cord tumours: A retrospective study of sur­gical outcomes

Background: Intradural extramedullary spinal cord tumours (IESCT) accounts for approximately two thirds of all intraspinal neoplasm and are of important clinical consideration and surgery is the essence in cases with neurological deterioration.Objective: To share our experience on the outcome of surgical excision of intradural extramedullary spinal cord tumours. Methods: Results of 60 patients surgically treated intradural extramedullary spinal tumours between Octo­ber 2003 and October 2015 at Bangabandhu Sheikh Mujib Medical University and in our private settings, Dhaka, were analyzed retrospectively. There were 32 males, 28 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumours location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade.Results: The tumours were located as, thoracic 32 (53.33%), lumbar 16 (26.67%), cervical 04 (6.67%), and junctional 08 (13.33%), CervicoThoracic-01, Thoracolumbar-07). The histopathological diagnosis included schwannoma 35 (58.33%), meningiomas 14 (23.33%), neurofbroma 4 (6.67%), arachnoid cyst and myxopapillary ependymoma 03 (05.00%) each and paraganglioma 01 (01.67%). The VAS score was reduced in all cases from 8.0 ± 1.2 to 1.2 ± 0.8 (p &lt; 0.003) and the Nurick's grade was improved in all cases from 3.0 ± 1.3 to 1.0 ± 0.0 (p &lt; 0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia, dependant bedsore 02 (3.33%) each and recurrence 03 (05.00%). and further neurological deterioration 1 (01.67%) case.Conclusion: lntradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgi­cally. Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome. ­

Improved patient quality of life following intradural extramedullary spinal tumor resection.

OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1-3 months postoperatively, 3-12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1-3, 3-12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.