The surgical treatment for spinal intradural extramedullary tumors.
BACKGROUND
We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors.


METHODS
The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred.


RESULTS
The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r(2) = 0.75, p = 0.010, Nurick's grade; r(2) = 0.69, p = 0.019). One case of schwannoma recurred.


CONCLUSIONS
The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.
Ahn
Dong-Ki
DK
Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
Park
Hoon-Seok
HS
Choi
Dae-Jung
DJ
Kim
Kwan-Soo
KS
Kim
Tae-Woo
TW
Park
Soon-Youl
SY
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery