Surgical Resection of Tumors of the Cauda Equina in the Absence of Intraoperative Neurophysiological Monitoring: Experience with 25 Cases

Abstract

Background data: Tumors of the cauda equina represent an uncommon group of tumors with diverse pathologies and clinical manifestations. Surgery represents the mainstay of treatment for these tumors. Study design: A retrospective case series was conducted. Purpose: This study evaluates the clinical outcome and the extent of resection in a group of patients operated upon for resectioning tumors of the cauda equina in the absence of intraoperative neurophysiological monitoring. Patients and methods: This retrospective study was conducted on 25 adult patients operated upon for resection of primary cauda equina tumors in the absence of intraoperative neurophysiological monitoring. The modi fi ed McCormick scale was used for the evaluation of the functional outcome of the patients 12 months after surgery. The outcome was graded into four groups: excellent, good, fair, or poor. The extent of resection was assessed by MRI with contrast. Results: The mean duration of symptoms before diagnosis was 13.8 ± 8.2 months. Low back pain was the most common symptom (96%), with 44% of the patients having neurological de fi cits at presentation. There were 13 nerve sheath tumors (nine schwannomas and four neuro fi bromas) (52%) and eight (32%) ependymomas. Gross total resection was achieved in 80% and subtotal resection was achieved in 16%, whereas partial resection was achieved in 4% of the patients. Excellent, good, fair, and poor clinical outcomes were achieved in 68, 4, 20, and 8% of the patients, respectively. Conclusion: Cauda equina tumors are mostly benign with a favorable prognosis. High rates of gross total resection with favorable clinical outcomes could be achieved in most of these tumors, even in the absence of intraoperative neurophysiological monitoring (2022ESJ258).