title: Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors.
abstract: OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;
authors.forename: Albert P
authors.initials: AP
authors.lastname: Wong
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Rishi R
authors.initials: RR
authors.lastname: Lall
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Nader S
authors.initials: NS
authors.lastname: Dahdaleh
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Cort D
authors.initials: CD
authors.lastname: Lawton
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Chicago Pritzer School of Medicine, Chicago, Illinois;
authors.forename: Ricky H
authors.initials: RH
authors.lastname: Wong
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Harvey
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
authors.affiliation: Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago;
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Koski
authors.affiliation: 'Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Fessler
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; EBL = estimated blood loss; GTR = gross-total resection; ID-EM = intradural-extramedullary; MIS = minimally invasive surgery; extramedullary tumor; intradural tumor; intradural-extramedullary tumor; minimally invasive surgery; spine surgery; spine tumor