title: Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience.
abstract: OBJECTIVE
  Intradural extramedullary (IDEM) neoplasms are uncommon lesions that can pose a challenge for resection. Numerous factors affect the resectability and ultimately the outcome of these lesions. The authors report their 10-year institutional experience with the resection of IDEM neoplasms, focusing on the effect of location on surgical outcomes.
  
  
  METHODS
  The authors performed a retrospective review of 96 consecutive patients who presented with a cervical and/or thoracic IDEM tumor that was resected between February 2000 and July 2009. All patients underwent MRI, and the axial location of the tumor was categorized as anterior, posterior, or lateral. Postoperative complications were assessed, as was neurological status at the patient's last follow-up clinic visit. Major complications assessed included CSF leakage requiring lumbar drainage, reexploration for epidural hematoma, and major postoperative neurological deficits.
  
  
  RESULTS
  The mean ± SD age at presentation was 51.16 ± 17.87 years. Major surgical approach-related complications occurred in 15% of patients. Major non-approach related surgical complications occurred in 7.1% of patients, while minor complications occurred in 14.2% of patients. Postoperative neurological deficits occurred most commonly in the thoracic spine between T-1 and T-8. Based on axial spinal cord location, the surgery-related complications rates for all anterior tumors (n = 12) was 41.6%, whereas that for all lateral tumors (n = 69) was 4.4% and that for all posteriorly located tumors (n = 17) was 0%.
  
  
  CONCLUSIONS
  Spinal IDEM tumors that are anteriorly located in the upper thoracic spine were found to have the highest rate of surgery-related complications and postoperative neurological deficits. This finding may be associated with the unforgiving anatomy of the upper thoracic spine in which there is a higher cord-to-canal ratio and a tenuous vascular supply.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; and.
authors.forename: Ankit I
authors.initials: AI
authors.lastname: Mehta
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Paul
authors.initials: P
authors.lastname: Thompson
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.forename: Ulysses T
authors.initials: UT
authors.lastname: Null
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000592:standards; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000209:etiology*; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome