Intradural extramedullary spinal masses treated at the Wits teaching hospitals between 2014 – 2017

Abstract

Background: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant  neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching  hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and2017.

Results: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to  diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had  severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour  types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and  lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed,  and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was  unchanged in the remainder.

Conclusions: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and  though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery