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Vol. 34. Issue 5.
Pages 256-267 (September - October 2023)
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Vol. 34. Issue 5.
Pages 256-267 (September - October 2023)
Clinical Research
Intradural extramedullary tumors. Retrospective cohort study assessing prognostic factors for functional outcome in adult patients
Tumores intradurales-extramedulares. Estudio retrospectivo de cohorte valorando factores predictores de «outcome» en pacientes adultos
Mauro Ruellaa,
Corresponding author
mruella@fleni.org.ar

Corresponding author.
, Guido Caffarattia, Amparo Saenzb, Facundo Villamila, Rubén Mormandia, Andrés Cervioa
a Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina
b Department of Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Tables (3)
Table 1. Summary of population's general characteristics and variables analyzed.
Table 2. Comparison of clinical results.
Table 3. Statistical analysis of factors associated to clinical outcome.
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Abstract
Objective

The purpose of this study is to analyze a series of patients with intradural extramedullary tumors (IDEM) and assess factors that may modify or determine the final long term outcome and management.

Materials and methods

Single Center, retrospective study of a series of surgical patients with IDEM lesions from our Institution operated between 2010 and 2021. Patients with less than 6 months of follow up were excluded. Several preoperative demographics, clinical, imaging and surgical features, as well as histopathology, recurrence and adjuvancy were assessed. Patients’ final clinical outcome was categorized using the McCormick scale.

Results

A total of 203 patients with a mean follow-up of 30.50 months (range 6–130) were included. 57.64% of the analyzed population was female and the mean age was 50.51 years.

The most frequent location of the tumors was dorsal (34.98%) followed by the lumbar region (32.02%). Total resection was achieved in 84.24% of cases, and the most frequent histopathology was Schwannoma (36.45%), followed by Meningioma (30.05%). Pain was the most usual initial symptom (63.05%).

In our analysis, functional outcome after surgery was associated with statistical significance with preoperative McCormick grade, tumor type, EOR and postoperative complications such as hematoma and sphincter involvement.

Conclusion

The management of these lesions depends on many factors. It is worthy of mention that clinical presentation, EOR, histopathology and postoperative complications have shown significant prognostic value for the final outcome. Early treatment with the intention of achieving GTR when possible, using carefully tailored approaches, should be considered before the onset of significant symptoms.

Keywords:
Intradural extramedullary lesions
Imaging
Management
Outcome
Abbreviations:
IDEM
CNS
TOR
MRI
DTI
KPS
EOR
IONM
SSEP
MEP
GTR
NTR
STR
PFS
SAC
SIH
DVT/PTE
Resumen
Objetivo

Analizar una serie de pacientes con tumores intradurales extramedulares y evaluar factores que pueden modificar o determinar el resultado final y el manejo a largo plazo.

Materiales y métodos

Estudio monocéntrico, retrospectivo de una cohorte de pacientes quirúrgicos con lesiones intradurales extramedulares (IDEM) operados entre 2010 y 2021 y un mínimo de seis meses de seguimiento. Se evaluaron características clínicas, de imagen y quirúrgicas, histopatología, recurrencia y adyuvancia. El resultado clínico final de los pacientes se categorizó utilizando la escala de McCormick.

Resultados

Se incluyeron un total de 203 pacientes con un seguimiento medio de 30,50 meses (rango 6-130). De la población analizada, 57,64% era del sexo femenino y la edad media fue de 50,51 años.

La localización más frecuente de los tumores fue dorsal (34,98%) seguida de la región lumbar (32,02%). La resección total se logró en 84,24% de los casos, y la histopatología más frecuente fue el schwannoma (36,45%), seguido del meningioma (30,05%). El dolor fue el síntoma inicial más habitual (63,05%).

En nuestro análisis, el resultado funcional posoperatorio se asoció con significancia estadística con el grado de McCormick preoperatorio, la histopatología, el grado de resección y las complicaciones posoperatorias como el hematoma y la afectación esfinteriana.

Conclusión

El manejo de estas lesiones depende de muchos factores. Cabe mencionar que la presentación clínica, el grado de resección, la histopatología y las complicaciones posoperatorias han mostrado un importante valor pronóstico para el desenlace. Se debe considerar el tratamiento temprano con la intención de lograr resección total cuando sea posible, mediante abordajes cuidadosamente adaptados, antes de la aparición de síntomas significativos.

Palabras clave:
Lesiones intradurales extramedulares
Imágenes
Manejo
Outcome

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