Microsurgical treatment of extramedullary intradural tumors of the spinal cord and roots of the horse's tail

Kocherezhkin B.A.

(Neurosurgical Clinic of the Moscow Regional Research Clinical Institute named after Vladimirsky M.F., Moscow, Russia)

The study is based on 62 patients subject to clinical-instrumental examination and surgical treatment. They were divided into main (36 cases) and control (26 cases) groups. The main group included (a) patients with meningiomas, removed with the help of a microsurgical method, worked out in our clinic, and (b) cases with neurinomas, removed by an ultrasonic suction device or a microsurgical method. The control group consisted of patients with tumors, removed by conventional methods. An age of cases in the main group varied from 14 up to 71 (a mean value of 49.5). Patients in the control group were at the age of 20-73 (a mean value of 51). There were 5 (14%) males and 31 (86%) females in the main group. These figures in the control group were equal to 6 (23%) and 20 (77%) respectively. Meningiomas and neurinomas were watched in 27 (75%) and 9 (25%) cases of the main group respectively. There were 17 (65%) patients with meningiomas and 9 (35%) patients with neurinomas in the control group. As for the main group, meningiomas were localized mainly at the middle and inferior thoracic levels and at the level of enlargements; neurinomas were watched at the level of the horse's tail roots and cervical enlargement. Usually meningiomas had ventrolateral, dorsolateral and dorsal localization in relation to the spinal cord diameter; neurinomas were of ventral and ventrolateral localization or were localized at the level of the horse's tail roots. Meningiomas in the control group, as compared with the main group, were watched more often at the middle thoracic level and the level of enlargements too; neurinomas were observed at the level of the horse's tail roots, lumbar enlargement and the inferior thoracic level. Meningiomas had ventrolateral and dorsolateral localization in relation to the spinal cord diameter; neurinomas were localized at the level of the horse's tail roots and ventrolaterally.

Surgical treatment of patients of the main group was carried out with the help of an operating microscope, microsurgical technique and instruments. Meningiomas were removed in accordance with a microsurgical method, worked out by us. It consisted in opening of a tumor capsule, excision of an intracapsular part of tumor by small fractions (3-5 mm) and vaporizing of tumor tissue by means of bipolar coagulation. Gradual decrease of a tumor volume made it possible to excise its remaining fragments from the spinal cord, its roots and vessels atraumatically. Then a tumor capsule was separated from adjacent tissues of the spinal cord and removed. Neurinomas were removed mainly with an ultrasonic suction device; in case of their high density a microsurgical method was used. Total resection was performed in all cases. As for the main group, good, satisfactory and bad results in a postoperative period (the 1st - 3rd day) were watched in 29 (80.6%), 6 (16.6%) and 1 (2.8%) patients respectively. In the control group they were as follows: good results - 11 (42.3%) cases, satisfactory results - 12 (46.2%) cases and bad results - 3 (11.5%) cases. Good, satisfactory and bad results on discharge were observed in 31 (86.1%), 3 (8.3%) and 1 (2.8%) patients of the main group respectively. Mortality was 2.8% (1 patient). The same indices in the control group were represented in the following way: good results - 14 (53.8%) cases, satisfactory results - 9 (34.6%) cases, bad results - 3 (11.6%) cases. There were no fatal outcomes.