Intradural Spinal Tumors—Review of Postoperative Outcomes Comparing Intramedullary and Extramedullary Tumors from a Single Institution's Experience

Ng, Zhixu; Ng, Shi Ling; Nga, Vincent Diong Weng; Teo, Kejia; Lwin, Sein; Chou, Ning; Yeo, Tseng Tsai

doi:10.1016/j.wneu.2017.09.143

Cited by 24 publications

(15 citation statements)

References 10 publications

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“…As we know, tumors located in the upper thoracic spine are more likely to develop postoperative neurological deficits because of anatomical limitations at these levels and insubstantial blood supply to that region. 1,6,9 The extradural extension may also have a propensity to cause root/spinal cord-related neurological deficits, and the chances of recurrence are also high in such cases, while cervical spinal schwannoma with extradural extension has more of a chance of recurrence than at any other location. [10][11][12][13] The surgical approach is determined primarily depending on the location of tumors in the spinal canal, although the standard posterior approaches through bilateral or unilateral laminectomy with or without unilateral medical facetectomy provide adequate exposure to safely remove the vast majority of these lesions.…”

Section: Discussionmentioning

confidence: 99%

“…The complete excision of the tumor helps to prevent recurrence; hence, it is also a good predictor of clinical outcome and should be attempted. 3,9,12,[19][20][21] Spine centers have started, as a routine practice, to do neurophysiological monitoring in most cases of spinal surgery across the globe, but still have not proven its utmost importance in IDEM tumors. 9,22 One benefit of intraoperative neuromonitoring is that it helps for intraoperative evaluation of nerve function and thus helps in excision of nonfunctional nerves.…”

Section: Discussionmentioning

confidence: 99%

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Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors

et al. 2021

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Background: Intradural extramedullary (IDEM) spinal cord tumors are two thirds of all spinal tumors. We have prospectively analyzed the importance of the tumor occupancy ratio as a factor for predicting the course of the disease and in prognosticating the surgical outcome in patients with IDEM tumors.Methods: We prospectively analyzed 44 consecutive cases of IDEM tumors, diagnosed as cervical, thoracic, and lumbar IDEM tumors (excluding conus/cauda equina lesion) by magnetic resonance imaging (MRI), that were operated on at our institution between 2014 and 2016. We measured the tumor occupancy ratio and noted the sagittal and axial location of the tumor in the preoperative MRI and performed the laminectomy and unilateral medial facetectomy. A primary outcome has been noted according to the gait disability score in the preoperative period and in the follow-up period of 1 year. In the statistical analysis, categorical variables were compared using a chi-square test, and an analysis of variance and student t tests were used for the continuous variables. P , .05 was considered statistically significant.Results: The tumor occupancy ratio showed a significant association to the preoperative gait disability score (P , .001) and also predicted that the surgical outcome is much better in patients with tumors with a low tumor occupancy ratio than in patients with tumors with a high occupancy ratio (P , .001). No difference in the tumor occupancy ratio was noted in 2 different pathological tumors, and there was also no difference in the tumor occupancy ratio at different sagittal and axial locations of the tumor. Conclusion:Tumor occupancy ratio has shown a significant impact on the preoperative course and also predicts the surgical outcome in patients with IDEM tumors. Hence, it is an important imaging characteristic to prognosticate the outcome in IDEM tumors and should be noted in each case.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors

et al. 2021

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“…Our cohort of patients had features similar to the published literature in as far as age and gender occurrence of IDEM tumours are concerned, as well as main clinical features. [2][3][4] The frequency of IDEM tumours as a subset of all spinal tumours varies widely in the literature, as does the relative prevalence of the different types of tumour within this group. 2,[4][5][6] Our patients do, on average, present late.…”

Section: Discussionmentioning

confidence: 99%

Intradural extramedullary spinal masses treated at the Wits teaching hospitals between 2014 - 2017

Ouma¹

2019

S. Afr. j. surg.

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Background: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and2017. Results: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. Conclusions: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.

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“…С другой стороны, в исследовании Z. Ng с соавт. [19] показано, что применение нейрофизиологического мониторинга не влияет на исходы хирургического лечения данной группы пациентов, однако авторы акцентируют внимание на достижении максимально возможной степени резекции опухоли. C. Fisahn с соавт.…”

Section: Discussionunclassified

Long-Term Results of Surgical Treatment in Patients With Intradural Spinal Tumors

et al. 2018

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Background: Intradural spinal cord tumors include extramedullary and intramedullary tumors. The search for literature sources in the Pubmed, Medline, and E-Library databases detected a little number of researches on the long-term results of the surgical treatment of intradural spinal cord tumors. These clinical series include a small number of patients and do not consider the factors influencing clinical outcomes of surgical treatment.Aim: To evaluate the long-term results of surgical treatment in patients with intradural spinal cord tumors, to identify the main factors influencing the clinical and neurological outcomes of surgical interventions in this group of patients.Materials and methods: The study included 277 medical records of 244 patients with intradural extramedullary and 33 patients with intradural intramedullary tumors of the spinal cord. Clinical-neurological outcomes of surgical treatment in patients with intradural spinal cord tumors and factors influencing the outcomes were analyzed.Results: When comparing the degree of neurologic deficit in patients with intradural extramedullary tumors prior to surgery, no significant differences were found (p=0.241) both in the early postoperative period and 6 months after the surgery. Nevertheless, when comparing these indicators in a period of 12, 24, 36, 48, and 60 months after the surgery, statistically significant differences were revealed (p0.001). There was no statistically significant difference (p=0.437) between the scores in patients with intramedullary tumors on the modified McCormick Scale preoperatively, at the 6-month and one-year follow-up; however, comparison of the clinical and neurological indicators at 24, 26, 48, and 60 months revealed a significant difference (p0.001). The surgery outcomes in considered groups of patients were significantly influenced by the following indicators: the ASA risk level (odds ratio (OS) 2.138; 95% confidence interval (95% CI) 3.346–12.145) and intraoperative neurophysiological monitoring (OR 2.84; 95% CI 1.67–9.56).Conclusion: The study registered good and excellent long-term outcomes in most cases of intradural spinal cord tumors when the maximum possible tumor excision was performed. Analysis of the influence of various factors on the clinical and neurological outcomes in the study group of patients showed that the use of intraoperative neurophysiological monitoring and the degree of operational and anesthetic risk according to the ASA scale have a significant effect.

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Intradural Spinal Tumors—Review of Postoperative Outcomes Comparing Intramedullary and Extramedullary Tumors from a Single Institution's Experience

Cited by 24 publications

References 10 publications

Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors

Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors

Intradural extramedullary spinal masses treated at the Wits teaching hospitals between 2014 - 2017

Long-Term Results of Surgical Treatment in Patients With Intradural Spinal Tumors

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