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

Abstract

<p><strong>Background:</strong> 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.</p><p><strong>Objective:</strong> 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.</p><p><strong>Results:</strong> 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 < 0.003) and the Nurick's grade was improved in all cases from 3.0 ± 1.3 to 1.0 ± 0.0 (p < 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.</p><p><strong>Conclusion:</strong> 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. ­</p>

Functional Outcomes following Surgical Management of Intradural Extramedullary Spinal Cord Tumors

“…Many studies of intradural extramedullary tumors reported marked improvement of pain after surgery. Ahn et al, 1 revealed that the mean VAS score was reduced in all cases from 8 before surgery to 1.2 after surgery, whereas Ahsan et al, 2 reported a reduction of the mean VAS score from 7.67 preoperatively to 1.14 postoperatively. Consistent with previous studies, in our series the mean VAS score was reduced from 7.8 preoperative to 1.6 postoperative.…”

“…Similarly, Gu et al, 6 revealed that 93% of their patients had improved frankel grade, whereas 7% of patients had no change in their grade after surgery. Ahsan et al, 2 and Ahn et al 1 reported that the mean Nurick's grade has improved from 3 preoperatively to one postoperatively. Consistent with previous studies, in our series there was improvement of the mean Nurick's grade from 3.1 preoperatively to 1.6 postoperatively.…”

“…Early diagnosis and early management of spinal tumors remain the most crucial elements affecting the outcome of such tumors. 2 Prevedello et al, 14 studied 44 patients with intradural extramedullary tumors, their mean age was 32.9 years, most of tumors were located at the thoracic spine (45.5%), Schwannoma was the most common` tumor (65.9%) followed by meningioma (20.5%). Similarly in our series, most of our patients were in 3 rd and 4 th decade of their life, thoracic spine was the commonest location and Schwannomas were the commonest type of tumor encountered.…”

Minimally Invasive Hemilaminectomy Approach in Cases of Intradural-Extramedullary Spinal Tumors: Local Experience

“…Many reports about intradural-extramedullary tumors reported significant pain improvement after surgery. Ahn et al 1 documented that the mean VAS score was decreased in their patients from 8 before surgery to 1.2 after surgery, whereas Ahsan et al 2 reported a reduction of the mean VAS score from 7.67 preoperatively to 1.14 postoperatively.…”

“…Konovalov et al 9 reported that 50% of patients moved to a higher functional class of McCormick scale after laminectomy and resection of the tumor. Ahsan et al 2 and Ahn et al 1 reported that the mean Nurick's grade has improved from three preoperatively to one postoperatively. Similarly, Gu et al 7 revealed that 93% of their patients had improved Frankel grade 1 preoperatively to grade 1.6 postoperatively, whereas 7% of patients had no change in their grade after surgery.…”