Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: A 10-year single-institutional experience

Ankit I. Mehta, Owoicho Adogwa, Isaac O. Karikari, Paul Thompson, Terence Verla, Ulysses T. Null, Allan H. Friedman, Joseph S. Cheng, Carlos A. Bagley, Robert E. Isaacs

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Object. 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.

Original languageEnglish (US)
Pages (from-to)701-707
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume19
Issue number6
DOIs
StatePublished - Dec 1 2013

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antineoplaston A10
Neoplasms
Thorax
Spine
Ambulatory Care
Hematoma
Blood Vessels
Drainage
Spinal Cord
Anatomy

Keywords

  • Extramedullary spinal tumor
  • Meningioma
  • Neurofibroma
  • Oncology
  • Schwannoma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors : A 10-year single-institutional experience. / Mehta, Ankit I.; Adogwa, Owoicho; Karikari, Isaac O.; Thompson, Paul; Verla, Terence; Null, Ulysses T.; Friedman, Allan H.; Cheng, Joseph S.; Bagley, Carlos A.; Isaacs, Robert E.

In: Journal of Neurosurgery: Spine, Vol. 19, No. 6, 01.12.2013, p. 701-707.

Research output: Contribution to journalArticle

Mehta, Ankit I. ; Adogwa, Owoicho ; Karikari, Isaac O. ; Thompson, Paul ; Verla, Terence ; Null, Ulysses T. ; Friedman, Allan H. ; Cheng, Joseph S. ; Bagley, Carlos A. ; Isaacs, Robert E. / Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors : A 10-year single-institutional experience. In: Journal of Neurosurgery: Spine. 2013 ; Vol. 19, No. 6. pp. 701-707.
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abstract = "Object. 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.",
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T2 - A 10-year single-institutional experience

AU - Mehta, Ankit I.

AU - Adogwa, Owoicho

AU - Karikari, Isaac O.

AU - Thompson, Paul

AU - Verla, Terence

AU - Null, Ulysses T.

AU - Friedman, Allan H.

AU - Cheng, Joseph S.

AU - Bagley, Carlos A.

AU - Isaacs, Robert E.

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N2 - Object. 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.

AB - Object. 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.

KW - Extramedullary spinal tumor

KW - Meningioma

KW - Neurofibroma

KW - Oncology

KW - Schwannoma

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