30-day sepsis risk after laminectomy for resection of intradural extramedullary (IDEM) tumors based on NSQIP database: a critical appraisal
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SUBMITTER: Varghese V
PROVIDER: S-EPMC9547695 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
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Project description:Study designRetrospective cohort study.ObjectivesIntraoperative neurophysiological monitoring (IONM) is widely used in spinal neurosurgery, particularly for intramedullary tumours. However, its validity in intradural extramedullary (IDEM) spinal tumours is less clearly defined, this being the focus of this study.MethodsWe compared outcomes for patients that underwent resection of IDEM tumours with and without IONM between 2010 and 2020. Primary outcomes were postoperative American Spinal Injury Association (ASIA) scores. Other factors assessed were use of intraoperative ultrasound, drain placement, postoperative complications, postoperative Eastern Cooperative Oncology Group (ECOG) score, extent of resection, length of hospital stay, discharge location and recurrence.Results163 patients were included, 71 patients in the IONM group and 92 in the non-IONM group. No significant differences were noted in baseline demographics. For preoperative ASIA D patients, 44.0% remained ASIA D and 49.9% improved to ASIA E in the IONM group, compared to 39.7% and 30.2% respectively in the non-IONM group. For preoperative ASIA E patients, 50.3% remained ASIA E and 44.0% deteriorated to ASIA D in the IONM group, compared to 30.2% and 39.7% respectively in the non-IONM group (all other patients deteriorated further). Length of inpatient stay was significantly shorter in the IONM group (P = .043). There were no significant differences in extent of resection, postoperative complications, discharge location or tumour recurrence.ConclusionsResearch focusing on the use of IONM in IDEM tumour surgery remains scarce. Our study supports the use of IONM during surgical excision of IDEM tumours.
| S-EPMC11289564 | biostudies-literature
Project description:In adults, spinal ependymomas are usually found in intramedullary locations. However, intradural extramedullary spinal ependymomas are rare. Additionally, spinal ependymomas usually show iso to hypointensity on T1-weighted images without hemorrhage. Herein, we present a rare case of a 43-year-old female with a pathologically confirmed intradural extramedullary ependymoma that showed hyperintensity on T1-weighted imaging accompanied by hemorrhage.
| S-EPMC10721411 | biostudies-literature
Project description: Not available
| S-EPMC10982912 | biostudies-literature
Project description: Not available
| S-EPMC7337270 | biostudies-literature
Project description:IntroductionIntradural extramedullary (IDEM) spinal cord tumors account two thirds of all intraspinal tumors. These tumors produce pain syndromes, a variety of neurological symptoms-motor, sensory, sphincter or a combination of thereof. Preferred treatment is microsurgical radical resection. The objective of this study was analyzed and discuss about functional outcome in IDEM.Presentation of caseWe present serial case of 15 patients, that consist of 8 males and 7 females, with the mean age of 43,4 years old, ranging from 16 to 82 years old. The outcomes were followed up with Karnofsky Score and Tomita to analyzed metastasis of the tumor. The mean of Karnofsky score in this study was 74 with no patient had metastatic intradural tumor, therefore the Tomita score in these patients is incalculable.DiscussionMRI confirmed the location and extent of the tumor for definitive diagnosis. We then performed excision of the tumor or decompression of the spinal canal followed by posterior stabilization if needed. Minimal complaint regarding pain and/or numbness were found. Post operation functional outcome of the patient is monitored using Karnofsky score.ConclusionIn all except one patient, the functional outcome of the patients is greater than 50 based on Karnofsky score. In this case series, the good functional outcome is due to all tumor were primary tumor which originate from the spine. Furthermore, all tumor had benign characteristic based on the anatomical pathology result. In consequence, gross total resection can be achieved thus resulting a good overall functional outcome of the patients.
| S-EPMC7201154 | biostudies-literature
Project description:ObjectiveTo identify the incidence and risk factors for 30-day postoperative mortality after microsurgical head and neck reconstruction following oncological resection.Study designRetrospective case-control study.SettingAmerican College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.MethodsMicrosurgical head and neck reconstructive cases were identified from 2005 to 2018 using Current Procedural Terminology codes and oncologic procedures using the International Classification of Disease 9 and 10 codes. The outcome of interest was 30-day mortality.ResultsThe 30-day postoperative mortality rate was 1.2%. Univariate logistic regression analysis identified the following associations: age >80 years, hypertension, poor functional status, preoperative wound infection, renal insufficiency, malnutrition, anemia, and prolonged operating time. Multivariable logistic regression models were used to stratify further by the degree of malnutrition and anemia. Hematocrit <30% was found to be an independent risk factor for 30-day postoperative mortality (odds ratio [OR] = 9.59, confidence interval [CI] 2.32-39.65, P < .1) with albumin <3.5 g/dL. This association was even stronger with albumin <2.5 g/dL (OR = 11.64, CI 3.06-44.25, P < .01). One-third of patients (36.6%) had preoperative anemia, of which less than 1% required preoperative transfusion, although one-quarter (24.6%) required intraoperative or 72 hours postoperative transfusion.ConclusionsPreoperative anemia is a risk factor for 30-day postoperative mortality. This association seems to get stronger with worsening anemia. Identification and optimization of such patients preoperatively may mitigate the incidence of 30-day postoperative mortality.
| S-EPMC8489772 | biostudies-literature
Project description:Introduction:Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation:We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion:We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion:Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.
| S-EPMC6786287 | biostudies-literature
Project description:BackgroundMesenchymal chondrosarcoma (MCS) is a rare malignant variant of chondrosarcoma with a high tendency of recurrence and metastasis. Intradural extramedullary spinal MCS is exceedingly rare and usually found in pediatric patients. Herein, we present an elderly patient with primary intradural extramedullary spinal MCS. Relevant literatures are reviewed to disclose characteristics of intradural extramedullary spinal MCS.Case presentationA 64-year-old female presented with urinary difficulty and tightness of upper back preceding progressive weakness of right lower extremity. Magnetic resonance imaging revealed an intradural extramedullary tumor at the level of 3rd thoracic vertebra. This patient underwent total tumor resection and then received adjuvant radiotherapy. Histopathological examination showed that the tumor composed of spindle and round cells with high nucleocytoplasmic ratio accompanied by scattered eosinophilic chondroid matrix. Along with immunohistochemical findings and the existence of HEY1-NCOA2 fusion transcript, the diagnosis of MCS was confirmed. Neurologic deficit recovered nearly completely after surgery. No evidence of local recurrence or distant metastasis was found 5 years after treatments. Including the current case, a total of 18 cases have been reported in the literature with only one case with local recurrence and one case of mortality. The current case was the eldest patient diagnosed with primary intraspinal MCS in the literature.ConclusionsMCS rarely appears in the intradural space of the spine. In contrast to classic MCS, treatment outcome of primary intradural extramedullary spinal MCS is usually excellent as total tumor resection is commonly achievable. Adjuvant radiotherapy may reduce local recurrence and chemotherapy may be associated with fewer recurrences especially for unresectable tumors.
| S-EPMC6727557 | biostudies-literature
Project description:BackgroundMyxopapillary ependymomas and schwannomas represent the most common tumors of the conus medullaris and cauda equina. Here, we present the surgical resection of a 64-year-old male with a lumbar intradural tumor.Case descriptionA 64-year-old male presented with several months of the lower extremity weakness, pain, and bowel/bladder dysfunction. Magnetic resonance imaging demonstrated a large L3-5 intradural lesion, and surgical resection using intraoperative neuromonitoring with somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), free-running electromygraphy (EMGs), and direct sphincter monitoring was recommended. After an L2-S1 laminectomy was performed, intraoperative ultrasound was used to confirm the cranial and caudal extent of the tumor. The dural was opened using a midline approach, and the tumor was quickly visualized. Through careful dissection, the tumor was debulked and gross total resection was ultimately achieved through a piecemeal resection. Hemostasis was frequently required throughout the case, as the tumor was highly vascular. Postoperatively, the patient was at his neurologic baseline and was discharged to rehab on postoperative day 4. The final pathology revealed the intradural lesion was a paraganglioma.ConclusionEarly intervention and gross total resection of spinal intradural tumors are associated with optimal patient outcomes. Additional adjuncts, such as ultrasound, are beneficial and can help achieve gross total tumor resection.
| S-EPMC10629344 | biostudies-literature
Project description:OBJECTIVE::Prior studies advocate the subjective visual differences between meningioma and schwannoma on T2 weighted images, however objective measurement of signal intensity differences may be useful in certain cases. The aim of this study was to investigate whether an objective evaluation of SIs on T2 weighted images would be useful to differentiate spinal schwannomas from meningiomas. METHODS::The patients with spinal MRIs demonstrating path proven and subsequently treated intradural extramedullary spinal tumors were selected between April 2008 and May 2017. Regions of interest (ROIs) were measured in the tumor and subcutaneous fat on the same image, and we calculated the SI ratio between tumor and fat ROIs. RESULTS::Twenty patients each with meningioma and schwannoma were enrolled. The SI ratios of schwannomas were significantly higher than those of meningiomas (both researcher 1 and 2: p = 0.002). The areas under the curve by researchers 1 and 2 were 0.780. The cutoff value of SI ratio by both of researchers 1 and 2 to differentiate between schwannomas from meningiomas was 0.420 (sensitivity: 80.0%, specificity: 70.0-75.0%). CONCLUSION::The SI ratio, calculated from the SIs of the tumor and fat on T2 weighted images, is useful for differentiating spinal schwannomas from meningiomas to obtain an accurate diagnosis. ADVANCES IN KNOWLEDGE::Signal intensity ratio of the spinal tumor and fat on T2 weighted images is useful for differentiating schwannomas from meningiomas to obtain an accurate diagnosis.
| S-EPMC6319836 | biostudies-literature