Intradural Extramedullary Spinal Cord Tumors: A Retrospective Study of Tumor Types, Locations, and Surgical Outcomes

摘要

Introduction: Intradural extramedullary spinal cord tumors (IESCT) account for approximately two thirds of all intraspinal neoplasms. The purpose of this report was to determine short- and long-term outcomes of surgical patients with IESCT, and to examine clinical features that could be helpful in management of patients with these lesions. Methods: A retrospective review of 67 operative IESCT cases between 1974 and 2001 was performed. Outcomes were scored at one month and at mean follow-up of 8.5 months postoperatively. In addition, patient demographics, tumor types and locations were also collected. Statistical analysis was conducted utilizing Chi-square and Student's t-tests. Results: There were 31 men and 36 women (mean age 48 y/o, range 18-87 y/o). Men presented at a younger age than women (44 vs 53 y/o, P<0.02). Fifty-seven (85%) patients presented with severe radiculopathy and/or myelopathy. The remaining 10 (15%) had symptoms typical of disc herniation. Mean duration of symptoms prior to diagnosis was 11 months. Schwannomas (36 patients) had the longest mean duration of symptoms (14.9 months), followed by meningiomas (21 patients, 8.4 months), and ependymomas (10 patients, 2 months). Sixty-three (94%) of patients demonstrated significant improvement at one-month and 62 (92%) at 8.5-month mean follow-up as compared to the index exam. Only 13/67 (19.4%) patients had residual focal deficits on long term follow-up. Conclusions: Surgery for IESCT should be expected to produce significant and dramatic improvement in great majority of patients. Demographic, tumor-specific and anatomic considerations may be clinically useful when approaching IESCT. Introduction Spinal tumors account for only approximately 5-15% of the nervous system neoplasms (1, 2). Intradural extramedullary spinal cord tumors (IESCT) constitute approximately two thirds of these tumors (2, 3). Relatively few published reports have sufficient sample sizes to adequately analyze surgical outcomes, demographics, symptoms, and data on tumor types and locations (3,4,5,6). The most commonly encountered types of IESCT are schwannomas and meningiomas, with myxopapillary ependymomas encountered less frequently. The primary objective of this study was to examine surgical outcomes following procedures for IESCT in a large retrospective cohort of patients. Secondary goals included examination of clinical data pertaining to demographics, symptoms, tumor location and type that could be helpful in clinical decision making. Materials and Methods This is a retrospective study of 67 surgical patients who underwent operative removal of IESCT between September 1974 and May 2001. Parameters recorded include patient demographics, symptoms (severity and duration), tumor characteristics (anatomic and pathologic), postoperative follow-up and surgical outcomes. Surgical intervention was indicated by a combination of presenting symptoms (radiculopathy and/or myelopathy) and radiographic findings of magnetic resonance imaging (MRI), and computed tomographic (CT)-myelography. The neuroimaging procedure of choice was contrast-enhanced MRI. CT-myelography was used in selected patients. Angiography was helpful in cervical dumbbell-shaped lesions. Patient charts were reviewed by one of the authors (SPS or JJG) and pertinent chart data was recorded in a computerized database (Microsoft Excel, Redmond, WA, USA). Surgical outcomes were scored at 1 month and then at the mean follow-up period. The mean follow-up was calculated from the interval between surgery and the last complete clinical examination in the patient chart (in this study, 8.5 months). Patient records were carefully reviewed and surgical outcomes were scored strictly according to the modified criteria of Odom, et al (Table 1) (7). While recognizing the shortcomings of the Odom's criteria as a ‘rough' outcome and morbidity assessment scale, we chose to use this method because of the uniform and standardized recording of these criteri