Clinical outcome of intradural extramedullary spinal cord tumors: A single-center retrospective analytical study

Abstract

Background: Intradural extramedullary spinal cord tumors (IESCT) account for approximately two-thirds of largely benign intraspinal neoplasms. They occasionally present with acute neurological deterioration warranting emergent surgical intervention.

Methods: Here, we reviewed a series of 31 patients with intradural extramedullary spinal tumors who underwent surgery from 2012 to 2019. Patients averaged 50.8 years of age, and there were 16 males and 15 females. Patients were followed for a minimum of 1 year. Multiple clinical outcome variables were studied (e.g., Karnofsky Performance Score [KPS], visual analog scale (VAS), and Frankel grade).

Results: The majority of IESCT tumors were found in the thoracic spine 18 (58.06%) followed by the lumbar 8 (25.80%), cervical 1 (3.22%), and combined junctional tumors 4 (12.90%) (cervicothoracic-02 and thoracolumbar-02). Histopathological diagnoses included schwannomas-16 (51.61%), meningiomas-11 (35.48%), lipomas-2 (6.45%), hemangiomas-1 (3.22), and ependymomas-01 (03.22%). The VAS score was reduced in all cases, while KPS and Frankel grades were significantly improved. Complications included cerebrospinal fluid leakage, new/residual paresthesias, and tumor recurrence (12.50%).

Conclusion: Most intradural extramedullary tumors are benign and are readily diagnosed utilizing MRI scans. Notably, good functional outcomes follow surgical intervention.

Keywords: Clinical outcome; Intradural extramedullary tumors; Spinal tumors; Surgical excision.

Figure 1:

The percentage of tumor occupying the intradural space (TOIDS%) - Transverse diameter of the tumor mass + the longitudinal diameter of the tumor mass/the transverse diameter of the intradural space + the longitudinal diameter of the intradural space ×100.

Figure 2:

Schwannoma (Arrow) – (a) (sagittal T2), (b) (post-contrast T1) lobulated heterogenous signal intensity lesion shows intense enhancement. (c) (axial T2), and (d) (post-contrast T1) lobulated heterogenous T1/T2 hyperintense intradural extramedullary lesion occupying left half of the spinal canal displacing cauda equina nerve roots toward the right.

Figure 3:

Meningioma (Arrow) – (a) (sagittal T2), (b) (post-contrast sagittal T1), (c) (axial T2), and (c) (post-contrast Axial 2D) - heterogenous mildly T2 hyperintense intradural extramedullary lesion with broad dural base and it shows intense contrast enhancement with small enhancing dural tail.

Figure 4:

Hemangioma (Arrow) – (a) (sagittal T1), (b) (post-contrast sagittal T1), and (c and d) (post-contrast axial T1 images) - Fairly marginated extramedullary intradural lesion appearing isointense to the adjacent cord on sagittal T1 sequence (3a image) occupying postero-central part of spinal canal, compresses and displaces cord anteriorly, and shows intense contrast enhancement.

Figure 5:

Lipoma (Arrow)– (a) (sagittal T2), (b-e) (axial T1 and axial T2 images) - T1/T2 hyperintense lesion occupying posterior part of the spinal canal compresses and displaces cord anteriorly. (Add fat sat and post-contrast images if possible).