Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

Zong, Shaohui; Zeng, Gaofeng; Xiong, Chunxiang; Wei, Bo

doi:10.1371/journal.pone.0063867

Cited by 20 publications

(19 citation statements)

References 24 publications

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“…Among those articles, hospitalization costs range widely secondary to the variability in the procedures performed, pathologies treated, and geographic location (such as different countries). 9,12,34,41,44 None of the available studies evaluate and compare the cost of both primary and metastatic spinal tumors. There are several articles that have examined the health care utilization and cost associated with the management of general bony metastasis and its associated "skeletal events," with some providing a subanalysis of spinal column metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of studies that directly evaluate the cost of surgery for spinal tumors. 9,12,34,41,44 Many of the past studies have focused on the health care costs associated with managing (medically and/or surgically) heterogeneous cohorts of patients with bony metastasis 8,13,14,17 or evaluated the cost effectiveness of adjuvant radiotherapy for spinal metastasis. 15 In addition, among those studies there is a lack of details regarding the type of procedure performed or a dedicated analysis of the factors that affect cost.…”

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confidence: 99%

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Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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“…To prevent the aforementioned complications, alternative, less-invasive surgical techniques are being developed by taking advantage of both the natural opening or passage in the bones of the spine and innovations in surgical instruments. 37, 49 The purpose of this present study was to report experiences with a novel minimally invasive technique, namely microsurgical resection of lumbar lesions via a "lossless" interlaminar approach. The authors use the word "lossless" to convey the concept of the most minimal injury ever possible to surrounding bony tissues while successfully removing the lesions in the spinal canal.…”

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confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.

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“…This is in line with the current literature, where resection rates of 93.0%-100% are described for minimally invasive approaches 21,26,28 and 70.5%-88.5% for open posterior approaches. 1,21,29,30 These rates may be attributed to preoperative selection; if large tumors that are difficult to fully resect are not approached in a minimally invasive way from the start, lower rates of resection would be expected in the open approaches. However, the feasibility of minimally invasive approaches is supported by the high resection rates for such approaches throughout the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Laminectomies, in comparison, were frequently reported with hospital stays of 7-27 days. 21,29,30 This difference may be explained by the larger wound and increased back pain and immobilization in laminectomies. However, the role of the health care system and its standards is not to be underestimated.…”

Section: Discussionmentioning

confidence: 99%

Keyhole approaches to intradural pathologies

Mende

Krätzig

Mohme

et al. 2017

Neurosurgical Focus

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OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.

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Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

Cited by 20 publications

References 24 publications

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Keyhole approaches to intradural pathologies

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