Outcome predictors in the surgical management of intradural spinal tumors

Abstract

Objective To evaluate the different factors affecting the surgical outcome of intradural spinal tumors. Background Among the intradural spinal tumors, meningiomas, ependymomas, astrocytomas, and nerve sheath tumors are the most common. Early surgical intervention with the use of technical adjunctives and postoperative adjuvant therapy has improved the outcome. Patients and methods A prospective study was done on 30 consecutive patients with an age group ranging from 20 to 60 years. All patients underwent surgery for intradural spinal tumors at Menoufia University and Alexandria Armed Forces Hospital. Data were collected regarding histopathological diagnosis, clinical presentation, tumor location, operative data, and postoperative complications. A functional outcome was assessed using the modified McCormick Scale (MMS). Results There were 16 (53.3%) patients with extramedullary tumors and 14 (46.7%) patients with intramedullary tumors. Guided tissue regeneration (GTR) was achieved in 21 (70%) patients, mostly meningioma and ependymoma. Extramedullary locations are more likely to achieve GTR and are associated with better outcomes than those with intramedullary locations. The mean preoperative MMS (2.70 ± 0.88) showed marked improvement compared with the mean 2.20 ± 1.42, 2.0 ± 1.51, and 1.93 ± 1.51 immediately postoperatively, 6-month, and 1-year follow-up, respectively. The complication rate was 33.3% (10 patients), and cerebrospinal fluid leak was the most common complication. Conclusion The use of adjunctive (cavitron ultrasonic aspirator, IOM), the extramedullary location, low preoperative MMS, GTR, and low tumor grade were associated with better postoperative outcomes.