Comparing Two Improved Techniques With the Traditional Surgical Techniques for Intra and Extramedullary Spinal Tumor Resection: A Report of 280 Cases

Abstract

Objectives: Spinal tumors remain a challenging problem in modern neurosurgery. The high rate of postoperative morbidity associated with intramedullary tumors makes the need for safer surgical techniques invaluable. This study analyses our experience with the treatment of spinal cord tumors and compares traditional management and a new different surgical approach to intramedullary tumors with an associated hydrosyringomyelia.

Materials and methods: This retrospective study compared standard surgical techniques and 2 newer modified techniques for intra and extramedullary spinal tumors at the Neurosurgery center for spinal cord tumors of the Republic of Uzbekistan. Preoperative neurological status was recorded with the ASIA/ISNCSCI scale. Postoperative outcome was graded using the Nurrick score.

Results: Of the 280 cases, there were 220 (78.5%) extramedullary and 60 (21.5%) with intramedullary spinal tumors. The control and main group had 159 (56.8%) and 121 (43.2%) patients, respectively. Severe compression myelopathy (ASIA- A, B, C) was 217 (77.5%) patients i.e., ASIA A-39 (13.9%); B-74 (26.4%), and C-104 (37.1%). In 74 extramedullary tumors (33.6%) treated with the new method, good postoperative outcomes in 44 cases (59.5%) with OR = 1.9; 95% CI 1.1-3.3 (p < 0.05). Thirty-seven (61.7%) intramedullary tumors were treated with the newer modified technique. There was no difference with the standard method (p = 0.15). However, when comparing postoperative Nurick grade 1-2 with grade 3-4, the newer strategy was superior with improvement in 24 (65%) patients, OR = 3.46; 95% CI 1.2-10.3 (p < 0.05).

Conclusion: When compared with standard methods, the proposed newer modified strategy of surgical treatment of spinal cord tumors with the insertion of a syringosubarachnoid shunt in the presence of an associated hydrosyringomyelia is associated with better postoperative outcome (Nurick 1 and 2) in 64.8%.

Keywords: Nurick score; differentiated surgical tactics; extramedullary tumors; intramedullary tumors; spinal cord tumors; syringohydromyelia.

Figure 1

Intraoperative images showing the insertion of the syringosubarachnoid shunt. The dura is opened (blue arrow), the tube is inserted into the resection dead space and into the syrinx (black arrow). The shunt is seen laying in the resection dead space is anchored to the overlying dura using a 6-0 silk suture (white arrow).

Figure 2

MRI of the cervical spine, preoperative and 2 days post-surgery. A 36-year-old with a Neuroma on the ventral surface of the spinal cord, at the level of C1-C2 (blue arrow). Control MRI shows total tumor removal using an improved method (orange arrow).

Figure 3

A pre-and post-surgery MRI of 32 years old with ependymoma of the roots of the cauda equina and syringomyelia between L3-L5 (blue arrow).