Functional outcomes in intradural extramedullary spinal tumors

Abstract

Background: Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient's quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care.

Methods: In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS).

Results: The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly.

Conclusion: The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.

Keywords: Denis pain scale; Frankel grade; Functional outcome; Intradural extramedullary spine tumors; Nerve monitoring.

Figure 1:

Pie chart showing presenting symptoms of patients with Intradural extramedullary (IDEM) tumours.

Figure 2:

Pie chart showing the sagittal distribution ofIntradural extramedullary (IDEM) tumours.

Figure 3:

Pie chart showing pathological types of Intradural extramedullary (IDEM) tumours.

Figure 4:

Preoperative magnetic resonance imaging-T2-weighted image showing meningioma at dorsal level.

Figure 5:

Preoperative magnetic resonance imaging-T2-weighted image showing dermoid at lumbosacral level.

Figure 6:

(a) Preoperative magnetic resonance imaging (MRI)-T2-weighted image (T2WI) showing schwannoma at the dorsal level and (b) postoperative MRI-T2WI of the dorsal spine after excision of schwannoma.

Figure 7:

Preoperative magnetic resonance imaging-T2-weighted image showing dumbbell-shaped neurofibroma at cervical level.

Figure 8:

Preoperative magnetic resonance imaging-T2-weighted image showing metastasis in an operated case of the left frontal anaplastic Oligodendroglioma (ODG) at dorsolumbar level.

Figure 9:

Preoperative magnetic resonance imaging CE-T1-weighted image showing metastasis in an operated case of the left frontal anaplastic Oligodendroglioma (ODG) at dorsolumbar level.