Surgery For Intradural Extramedullary Tumors Research Articles

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.

Improvement in Quality of Life Following Surgery for Intradural Extramedullary Tumors

Newman, William; Berry-Candelario, John MD; Villavieja, Jemma; Reiner, Anne; Laufer, Ilya MD; Bilsky, Mark H MD; Barzilai, Ori MD Author Information

Functional Outcomes following Surgical Management of Intradural Extramedullary Spinal Cord Tumors

Background Data: Intradural extramedullary tumors are mostly benign lesions that often present late due to their slow rate of growth. Recent advances in the field of neuro-imaging have greatly increased the ability to identify these tumors in early stages. The most effective treatment modality for these tumors is gross total resection, which can sometimes be associated with neurological morbidity and functional impairment. Purpose: to evaluate the functional outcomes following surgical excision of intradural extramedullary spinal tumors. Study Design: This is a retrospective cohort clinical case study. Patients and Methods: In this study the medical records of patients who underwent surgery for intradural extramedullary tumors at Ain Shams University Hospitals and Banha University Hospital between 2012 and 2015were reviewed. Patient’s demographics, clinical presentation, radiographic findings, tumor location, histopathological findings and neurological outcome were documented from patients’ files. Pain was evaluated by Visual Analog Scale and neurological function was graded before and after surgery by Nurick’s Functional Grading System. Results: This study included sixteen patients with intradural extramedullary mass lesions. Six were males (37%) and 10 were females (63%), mean age at presentation was 41 years (range 24 to 63 years). Histopathologically, there were 10 schwannomas (62%), 4 meningioma (%25) and 2 Neurofibromas (%13). Based on the location, we had 9 thoracic, 3 cervical and 3 lumbarlesions. There was improvement of the mean VAS score from 7.8 preoperative to 1.6 postoperative, as well as the mean Nurick’s grade from 3.1 preoperatively to1.6 postoperatively. Conclusion: Intradural extramedullary tumors are almost benign and slowly growing lesions that may be asymptomatic for many years before presentations. These tumors can be surgically excised through a standard posterior approach. Favorable outcome can be achieved by early diagnosis andearly treatment with maximal tumor resection. (2015ESJ100)

Surgical Technique and Clinical Outcomes for Primary Intradural Extramedullary Spinal Tumors

Background: Primary intradural extramedullary spinal tumors are rare and comprise nerve sheath tumors, meningiomas, and other rare pathologies. Clinical symptoms of these tumors are often nonspecific and are usually not obvious until neurological deterioration occurs. A delay in surgical treatment can lead to permanent neurological deficits. The aim of this study is to assess the clinical manifestations and surgical results of patients diagnosed with primary intradural extramedullary spinal tumors. Methods: From September 1999 to June 2014, patients who underwent surgery for primary intradural extramedullary spinal tumors at the orthopedic departments of authors' institutes were included in this study. Surgical procedures included laminectomy and midline durotomy for adequate exposure, total excision of tumors, and primary closure of durotomy by non-absorbable sutures. Spinal instrumentation and fusion was performed to prevent postlaminectomy kyphosis in only one patient whose tumor located in upper thoracic spine. The data were gathered retrospectively from medical records and included clinical presentation, tumor location, histopathology, postoperative complications and outcomes. Results: There were 11 patients, 5 males and 6 females, included in this study. The mean age of the patients was 52.8 (between 25 and 75) years. Preoperative symptoms included back pain in all cases, Brown-Sequard syndrome in the 3 cases of thoracic lesions, and sciatica-type of symptoms in 8 cases of lumbar lesions. The histopathologic results were meningiomas for 2 cases, schwannomas for 6 cases, paraganglioma for 1 case, ependymoma for 1 case, and mesenchymal chondrosarcoma for 1 case. Meningiomas and mesenchymal chondrosarcoma were located in the thoracic spine. Three schwannomas located at the level of conus medullaris. Paraganglioma, ependymoma, and the other three schwannomas located at the level of cauda equina. The case of mesenchymal chondrosarcoma received radiotherapy after surgery for the malignant nature of the tumor. All patients recovered well from preoperative symptoms after surgery. Persistent CSF leakage needed revision of dural repair was noted in one case. Iatrogenic spondylolisthesis at the operated levels was noted in one case but the patient declined the suggestion of additional spinal fusion because the clinical symptoms were minimal. No recurrence of tumor was found in the follow-up period. Conclusion: Although malignant lesions have been reported sporadically in the literature, intradural extramedullary tumors are usually benign. There is no typical presentation of clinical symptoms, therefore early-stage intradural extramedullary tumors are difficult to detect. Complete excision of these tumors is usually achievable and the neurologic prognosis after surgical excision is often better than the other spinal neoplasia.

Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not?

BackgroundWhile intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. MethodsFrom March 2008 to March 2013, 68 patients had microsurgery with IOM for IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas of the cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). The IOM included somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and – in selected cases – D-waves. Also preoperative and postoperative neurophysiological assessment was performed with SEPs and MEPs. All patients were evaluated at admission and at follow up (minimum 6 months) with the Modified McCormick Scale (mMCs). ResultsThree different IOM patterns were observed during surgery: no change in evoked potentials (63 cases), transitory evoked potentials change (3 cases) and loss of evoked potentials (2 cases). In the first setting surgery was never stopped and a radical tumor removal was achieved (no stop surgery group). In 3 cases of transitory evoked potentials change, surgery was temporarily halted but the tumors were at the end completely removed (stop and go surgery group). In 2 more patients the loss of evoked potentials led to an incomplete resection (stop surgery group). No patients presented a worsening of the pre-operative clinical conditions (at admission 47 patients presented mMCs 1–2 and 21 patients mMCs 3–5, while at follow up 62 patients are mMCS 1–2 and 6 patients mMCs 3–5). ConclusionsIn our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35%), and it is conceivable that the modification of the surgical strategy – induced by IOM – prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65%) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.

Treatment results in the different surgery of intradural extramedullary tumor of 122 cases.

Study DesignA retrospective study of intradural extramedullary tumor.ObjectiveTo compare the treatment results in the different surgeries of spinal intradural extramedullary tumor.MethodsThe study retrospectively reviewed 122 patients. The minimally invasive surgery (MIS) group was divided into Group A (hemilaminectomy + tumor microscopic excision) and Group B (laminectomy + tumor microscopic excision + pedicle screw fixation). Meanwhile, the non-MIS group was divided into Group C (hemilaminectomy + tumor excision), Group D (laminectomy + tumor excision), and Group E (laminectomy + tumor excision + pedicle screw fixation). In order to study postoperative spinal stability, we simultaneously divided all of the subjects into three categories, namely Group HE: hemilaminectomy + tumor excision; Group LE: laminectomy + tumor excision; and Group LEPSF: laminectomy + tumor excision + pedicle screw fixation.ResultsThe MIS group exhibited fewer postoperative complications (p<0.05), better short-term clinical efficacy (p<0.05) and less non-surgical cost (p<0.05) than in non-MIS group. The rate of postoperative spinal instability in hemilaminectomy was lower than in laminectomy in a single spinal segment (p<0.05). The rate of postoperative spinal instability in laminectomy + pedicle screw fixation was lower than in hemilaminectomy and laminectomy in two or more spinal segments (p<0.05).ConclusionIn the case of appropriate surgical indications, minimally invasive surgery for intradural extramedullary tumor is a useful method that can successfully produce good clinical results and reduce non-surgical cost. In addition, pedicle screw fixation helps avoid spinal postoperative instability.