INTRADURAL EXTRAMEDULLARY SPINAL CORD TUMORS : A RETROSPECTIVE STUDY OF LOCATIONS , TUMOR TYPES , AND SURGICAL OUTCOME

Dr. Sandeep Inchnalkar 1 , Dr. Kashif Ansari 2 , Dr. Suraj Mahadik 2 and Dr. Nikunj Shekhada 2 . 1. Mch (neurosurgery). 2. surgery post graduate. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Materials and Methods:-
This is a retrospective study of twenty five surgical patients underwent operative removal of IESCT between 2012 and 2014 at Dr. D. Y.PATIL HOSPIYTAL KOLHAPUR. Parameters recorded according to patients demographics, symptoms (severity and duration), growth characteristics (anatomic and pathologic), operative follow-up and surgical outcomes.
Surgical intervention was indicated by combination of presenting symptoms (radiculopathy and/or myelopathy) and photography findings of magnetic resonance imaging (MRI), and computed tomographic (CT)-myelography.
Surgical outcomes were scored at one month and so at the mean follow-up amount. The mean follow-up was calculated from the interval between surgery and therefore the last complete clinical examination within the patient chart (in this study, 9 months). Patient records were fastidiously reviewed and surgical outcomes were scored strictly in step with the changed 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 have a tendency to selected to use this methodology attributable to the uniform and standardized recording of those criteria altogether of our patient charts.
Descriptive statistics, Chi-square check and Student's t-test were used for knowledge analysis. Applied math significance was set at alpha = zero.05.

Results:-
There were seventeen ladies and eight men (mean age 48.7±16.56 y/o, median 45.7 y/o, varies 18-88 y/o). Overall, men of younger age group presented than ladies (44.1 vs 53.5 y/o, P&lt; 0.02). The age distribution was bimodal with a serious peak around 40 y/o and a minor peak at around 70 y/o. There were 3 primary growth types: schwannomas (10/25), meningiomas (8/25), and myxopapillary ependymomas (7/25) (Table 2A). Schwannomas were comparatively more common in men, meningiomas comparatively more common in ladies, and ependymomas distributed equally (Table 2A). Patients with meningiomas attended be older (57.6 y/o) than those with schwannomas (44.0 y/o) and ependymomas (40.2 y/o, P&lt; 0.01) (Table 2B). Growth locations varied between the 3 growths varieties in a very foreseeable fashion (Table 2C). Whereas schwannomas were distributed fairly equally among the 3 anatomic regions (cervical, thoracic, and lumbosacral), meningiomas predominated within the cervical and thoracic and ependymomas were predictably localized to the lumbar region. Of note, the magnitude relation of Schwannomas to Meningiomas to Ependymomas was around 5:4:2 during this study (actual magnitude relation 10:8:7).
The mean length of symptoms before designation was 11.3 months. Schwannomas had a statistically longer length of symptoms (14.9 months) than did meningiomas (8.4 months, P&lt; 0.05) for cervical and body part tumors. Ependymomas had shorter length of symptoms (2.0 months) than schwannomas (10.8 months, P&lt; 0.05) for lumbosacral tumors.

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Out of twenty five patients, 20 (80.0%) had good results at one month, and twenty two (88%) had good results at 9 months postoperatively (the mean follow-up, range 1.5 to thirty six months). At the one month follow-up, 32% (8/25) patients had wonderful results, 56% (14/25) had good results, 8% (2/25) had fair results, and 2.5% (1/25) had Poor result. The patient with a Poor result at one month follow-up had terribly severe presenting symptoms, had very little immediate post-surgical improvement, and however was upgraded to the good result upon future followup.
At mean follow-up of 9 months (range 1.5 to thirty six months), overall outcomes improved considerably. Fifteen patients (60%) had wonderful results, thirty second (8/25) had good results, and 8 %( 2/25) had fair results. Though at the 9 months mean follow-up the quantity of patients with poor results inflated by one, none of the patients had Poor results. The number of patients with wonderful results inflated by sixty fourth and therefore the number of patients with good results diminished by forty second (largely upgrades to wonderful). Just one patient with previously good result was downgraded to a fair result.
Three patients had multiple IESCT, all of that were schwannomas. One amongst these patients was NF-II positive. 3 patients developed repetition of their IESCT. 2 of those were schwannomas associate degreed one was an ependymoma.
While no metastases were noted throughout the 9 month mean follow-up amount (range one.5 to thirty six months), this study failed to specifically examine whether or not pathologic process illness did seem at a later time. No mortality was noted during this series, and therefore the solely complications enclosed a superficial wound infection and ending huskiness n one patient.

Discussion:-
Surgery for IESCT is that the best treatment choice manufacturing wonderful overall results, with completes microsurgical excision being the modality of selection (6,8). Trendy techniques change smart surgical outcomes with minmal morbidity and mortality (2, 3, 6, and 9). The present series corroborates this rivalry in this largely wonderful or smart results were achieved with few complications. In fact, no Poor results were noted during this study at the mean 9 month follow-up. Our findings believe those of others, with majority of clinical improvement noted either directly or at intervals 6 months of the operative intervention, with less notable clinical modification when this first amount (2). Alternative studies reported that length of surgical symptoms seems to correlate with operative improvement, which productive complete microsurgical neoplasm excision is of utmost importance (2, 2189 10,11). In terms of mortality, our result correlate well with alternative series, with a reported vary between 0-4.4% (2, 5, 12, and 13).
Approximately 2/3 of patients during this study intimate with residual focal deficits, none of that were disabling. Others report similar outcomes among patients with similarities to our patient sample, with important improvement in 62-88% of cases and clinical worsening in exactly a minority of patients (1-5%) (2, 3). Number of the patient outcomes and practical scores on discharge and/or follow-up might differ across studies because of different assessment tools being used by different authors (2,3).
Reported frequencies of schwannomas among IESCT vary from forty third to sixty seven in alternative studies (53.7% during this series) (2,6,14,15). Schwannomas tend to supply localized pain, radiculopathy, and bodily structure equina syndrome. Most report schwannomas to be solitary, with a 2.5% malignancy rate, which carries a poor prognosis (16). During this study, schwannomas were the sole cluster of tumors while not a predominant location of incidence, and grooved seventy fifth of perennial tumors.
In this series, patients with meningiomas were older than those with alternative neoplasm varieties. Findings during this series believe the literature in this meningiomas area unit the second commonest IESCT, with about 80% localized to the pectoral region (71% during this series) (6,10,16,17). Between 75% to 85% of patients with meningiomas area unit ladies (81% during this series), UN agency tend to be older than patients with schwannomas or ependymomas (6,10,16). In line with previous reports, we have a tendency to found meningiomas to be additional aggressive in younger patients, with the higher incidence of myelopathy probably because of predilection of meningiomas for the thoracic region (18). Others describe higher operative morbidity related to IESCT set within the thoracic region (6). Meningiomas tend to supply the "dural tail" check in imaging scans in sagittal, axial, and coronal planes, and it's counseled that every one 3 planes of image be used (19). We have a tendency to follow this recommendation as a result of as several as 100 percent of meningiomas will be each intradural and meninges (20).
Myxopapillary ependymomas represent 14.9% on IESCT during this study, and though during this study ependymomas had equal distribution among men and ladies, another series reported doubly as several men as ladies (21). During this series, the mean age of the ependymoma cluster was below the mean age of patients with tumor or schwannoma. Symptomatically, ependymomas cared-for turn out bodily structure equina syndrome, localized pain, and radiculopathy.
A 4:2:1 quantitative relation of schwannomas to meningiomas to ependymomas was ascertained during this series. Though not specifically delineate by others, similar quantitative relation of neoplasm varieties will be noted in previous reports (2,6,15).

Conclusions:-
Surgery for IESCT, with goal of complete neoplasm removal, may be a safe and effective choice. At the 9 month mean follow-up, majority of patients had complete or close to complete relief of symptoms and come back to full activity. In others, symptoms stopped progressing, and none of the twenty five patients worsened. Schwannomas and ependymomas were the sole histological varieties to recur. Demographic, tumor-specific and anatomic concerns are also clinically helpful once approaching IESCT.