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ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 63-68

Surgical outcome of spinal intradural extramedullary tumors: A Single-center prospective study of 92 cases— Assessment using nurick's grade and visual analog scale


1 Assistant Professor, Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
2 Senior Resident, Department of Obstetrics and Gynecology, Ananta Institute of Medical Science and Research Centre, Udaipur, Rajasthan, India
3 Senior Resident, Department of Neurosurgery, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India

Correspondence Address:
Vivek K Kankane
Assistant Professor Department of Neurosurgery, Sawai Man Singh Medical College Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10039-1172

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Introduction: To account the surgical outcome of 92 patients who underwent an entire removal of intradural extramedullary tumors (IDEMs) and evaluate the factors that have an influence on the neurological symptoms and prospects of spinal IDEM tumors. Materials and methods: Ninety-two cases of histopathologically confirmed IDEM tumors were treated surgically between July 2008 and July 2016. There were 32 females and 60 males with a mean age of 41.52 years. The mean postoperative follow-up period was 40.27 months. The histopathological result, locations of the tumors, and clinical outcome were analyzed. Backache was assessed by the visual analog scale (VAS) and the neurologic purpose was evaluated by Nurick's grade. The preoperative symptoms duration and the proportion of mass hold of the intradural space were evaluated. In adding up, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the magnetic resonance imaging (MRI) evaluated the tumor recurrence. Results: The histopathological outcomes are as follows: 28 cases of meningioma, 48 cases of nerve sheath tumors (40 cases schwannoma and 8 cases neurofibroma) (in our study, we included only non-dumbbell-shaped with no extracanalicular extended, posteriorly situated nerve sheath tumors, so these groups of tumors were excised completely with only posterior approach with preservation of facet), 10 cases of an arachnoid cyst, 2 case of Tarlov cyst, 1 case of benign cystic teratoma, and 3 cases were metastasis, and our study included only posteriorly situated tumors. The locations of the tumors were as follows: 64 cases in the thoracic region, 16 cases in the cervical region, and 12 cases in the lumbar region; postoperatively, there were two cases of cerebrospinal fluid (CSF) leakage; the majority of diagnosis consisted of nerve sheath tumors (52.1%), followed by meningioma (30.40%). The proportion of mass occupying the intradural space was 81.65 ± 9.01%. The VAS score was reduced in all cases from 7.56 ± 0.72 to 1.30 ± 0.47 (p = 0.001) and the Nurick's grade improved in all cases from 3.69 ± 0.92 to 1.35 ± 0.57 (p = 0.001). The preoperative symptoms were correlated with only the proportion of mass occupying the intradural space (VAS; r = 0.496, p = 0.016, Nurick's grade; r = 0.431, p = 0.040). The Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical study, and the Spearman correlation test and paired Student's t-test were performed. Two cases of schwannoma recurred. Conclusion: The IDEM tumors detected by MRI are frequently benign, and excellent clinical outcome can be obtained when treated surgically. The extent of neurologic symptoms was associated with the proportion of mass occupying the intradural space. All the tumors were capable of being excised through the posterior approach. The 'postoperative neurological improvement was outstanding in the entire cases. Consequently, violent surgical excision is suggested even for cases with a long period of symptoms or a rigorous neurologic deficit.


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