|Year : 2021 | Volume
| Issue : 1 | Page : 43-45
Clinicopathological study of intradural extramedullary spinal tumors in central Indian rural hospital: 6-year experience
Prasheelkumar Premnarayan Gupta1, Anil Vishnu Akulwar2, Deepak Premnarayan Gupta3, Richa P Goyal4
1 Department of Neurosurgery, MGIMS, Wardha, Maharashtra, India
2 Department of General Surgery, MGIMS, Wardha, Maharashtra, India
3 Department of Anesthesia, DMIMS, Wardha, Maharashtra, India
4 Department of Surgery, MGIMS, Wardha, Maharashtra, India
|Date of Submission||07-Jul-2020|
|Date of Acceptance||01-Feb-2021|
|Date of Web Publication||20-Mar-2021|
Dr. Anil Vishnu Akulwar
Vivekanand Block, Quarter No. 8, KHS Campus, MGIMS, Sevagram, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
BACKGROUND: Single institutional study of intradural extramedullary (IDEM) based on clinical presentation, location, and histopathological diagnosis.
AIM: The aim of this study is to evaluate a single institution-based epidemiology of IDEM spinal tumors in Rural Hospital of Central India.
MATERIALS AND METHODS: This study is retrospective observational study from July 2013 to July 2019 in the Department of Neurosurgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram. A total of 27 patients fulfilled the criteria and were included in the study. The case records of the patients were identified and studied for clinical manifestation, neurological examination, and radiological and histopathological diagnosis.
RESULTS: Out of total 35 spinal tumors, 27 patients were IDEM tumors (77.14%) with male-to-female ratio of 1:1.07. While spinal nerve sheath tumors were slightly more common in males, meningioma had significant female preponderance. The most common location of spinal tumor was dorsal spine and the most common histopathological type was schwannoma.
CONCLUSION: At present, no published study about epidemiology of IDEM tumors in central India is present. This study may provide the clinicopathological profile of various IDEM spinal tumors for our region.
Keywords: Intradural extramedullary, meningioma, schwannoma, spinal tumor
|How to cite this article:|
Gupta PP, Akulwar AV, Gupta DP, Goyal RP. Clinicopathological study of intradural extramedullary spinal tumors in central Indian rural hospital: 6-year experience. J Orthop Spine 2021;9:43-5
|How to cite this URL:|
Gupta PP, Akulwar AV, Gupta DP, Goyal RP. Clinicopathological study of intradural extramedullary spinal tumors in central Indian rural hospital: 6-year experience. J Orthop Spine [serial online] 2021 [cited 2021 Dec 3];9:43-5. Available from: https://www.joas.org.in/text.asp?2021/9/1/43/311612
| Introduction|| |
Spinal tumor comprises 5%–12% of total tumor of central nervous system. Spinal tumor being exceedingly rare occurs with an incidence of 0.77/100,000 in females and 0.70/100,000 in males. Overall incidence of spinal cord tumors was 0.74/100,000 person-years. On the contrary, intradural extramedullary (IDEM) tumor consists of 70% of all spine tumors. The most common IDEM tumor in Asian country is schwannoma followed by meningioma.,, Other less common tumors are myxopapillary ependymoma, lipoma, dermoid cyst, and arachnoid cyst.
Presenting symptom of IDEM depends on the location of tumor and surrounding mass effect. IDEM commonly presents with localized pain, which may be radiating to the limbs. Usually, pain may be nocturnal. Other symptoms can be sphincter dysfunction, paraparesis, and erectile dysfunction.
There is a paucity of literature regarding the IDEM tumors. At present, there are no data reported for the rural population of central India. Various studies conducted worldwide reported difference in the incidence of spinal IDEM; moreover, the incidence varies within the same country region wise. Some spine tumors (e.g., meningioma) are more predisposed to obesity, sedentary life, substance abuse, ionizing radiation, etc., which are more common in urban setup. Hence, our study will give the data pertaining to our region. The aim of the study is to report the clinic-pathological data about IDEM spine tumors for rural population of central India.
| Materials and Methods|| |
This is a retrospective study from July 2013 to July 2019 in the Department of Neurosurgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha. All the patients of IDEM spinal tumor operated during the abovementioned period, in the department of neurosurgery were included in the study.
A total of 27 patients fulfilled the criteria and were included in the study. The case records of the patients were identified and studied for clinical manifestation, neurological examination, and radiological and histopathological diagnosis. All the patients were operated by standard midline approach with laminectomy depending on the location of tumor. Due to the limited resources and unavailability of intraoperative monitoring device for our rural setup, motor-evoked potential and somatosensory-evoked potential were not performed in any of the case.
| Results|| |
During the study period, 35 patients of spinal tumor were operated, of which 27 patients were IDEM tumors (77.14%). Among 27 IDEM, 13 were male and 14 were female with male-to-female ratio of 1:1.07. The male-to-female ratio for spinal nerve sheath tumors (SNST) was 1.5:1, while in case of meningioma, it was 1:7. Age of the study population varies from 20 to 69 years with average age of 42.22 years. The most common presenting complaint was localized pain or radicular pain, followed by weakness in limb and bladder involvement [Table 1].
The most common location of IDEM tumor was dorsal, followed by lumbar spine and cervical spine [Table 2]. For SNST (schwannoma and neurofibroma) location in cervical, dorsal, and lumber spine was 13.33%, 46.67%, and 40%, respectively, while in case of meningioma, it was 12.5%, 75%, and 12.5%, respectively.
The most common histopathological type was schwannoma, followed by meningioma, neurofibroma, myxopapillary ependymoma, epidermoid, ganglioneuroma, and arachnoid cyst [Figure 1]. The most common histopathological type of meningioma was meningothelial variant (5 cases, 62.5%). Other observed variants were psammomatous (two cases, 25%) and angiomatous (one case, 12.5%).
| Discussion|| |
In our study, IDEM consists of 77.14% of total spinal tumor. It was significantly higher than other studies.,, It could be due to selection of more number of IDEM cases as compared to IDIM cases, as there is no facility of intraoperative monitoring in our department.
The most common IDEM tumor in our study was schwannoma accounting for 44.44% of the cases. The overall incidence of SNST (schwannoma and neurofibroma) was 55.56%. Arora et al. reported twenty cases of SNST (50%) out of total forty IDEM cases. The incidence of nerve sheath tumors was reported as 25% in the series reported by Levy et al. and McCormick,, Levy et al. found that males were affected more commonly than females, similar to our study. The most common location of SNST was dorsal spine, which corresponds to study done elsewhere.
The second most common tumor in our study was meningioma, which was similar to the observation by Bhat et al. In our study, male-to-female ratio for spinal meningioma was 1:7, which was similar to Mayo Clinic study and Lakshmi study., Majority of tumors (75%) were located in thoracic region, which is corresponding with 80% in a series of Mayo Clinic and 83% in a study by Roux et al. The most common histopathological variety observed in our study was meningothelial variant, followed by psammomatous variant. Roux et al. made similar observation to our study.
| Conclusion|| |
For the study population, we conclude that schwannoma is the most common histopathological variety of IDEM tumor, followed by meningioma. The most common location for IDEM tumor is dorsal spine. Schwannomas are more common in males, while meningiomas are most common in females. Most common presenting complaint is localized pain.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Newton HB. Overview of spinal cord tumor epidemiology. In: Newton HB, editor. Handbook of Neuro-Oncology Neuroimaging. 2nd
ed., Ch. 4. San Diego: Academic Press; 2016. p. 35-9.
Schellinger KA, Propp JM, Villano JL, McCarthy BJ. Descriptive epidemiology of primary spinal cord tumors. J Neurooncol 2008;87:173-9.
Traul DE, Shaffrey ME, Schiff D. Part I: Spinal-cord neoplasms-intradural neoplasms. Lancet Oncol 2007;8:35-45.
Hirano K, Imagama S, Sato K, Kato F, Yukawa Y, Yoshihara H, et al
. Primary spinal cord tumors: Review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J 2012;21:2019-26.
Su YF, Lieu AS, Lin CL, Lee KS, Hwang YF, Yen CP, et al
. Analysis of surgically treated intraspinal tumors in southern Taiwan. Kaohsiung J Med Sci 2007;23:573-8.
Suh YL, Koo H, Kim TS, Chi JG, Park SH, Khang SK, et al
. Tumors of the central nervous system in Korea: A multicenter study of 3221 cases. J Neurooncol 2002;56:251-9.
el-Mahdy W, Kane PJ, Powell MP, Crockard HA. Spinal intradural tumours: Part I—Extramedullary. Br J Neurosurg 1999;13:550-7.
Song KW, Shin SI, Lee JY, Kim GL, Hyun YS, Park DY. Surgical results of intradural extramedullary tumors. Clin Orthop Surg 2009;1:74-80.
Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long-term follow-up of intramedullary spinal cord tumors: A series of 202 cases. Neurosurgery 2005;56:972-81.
Bhat AR, Kirmani AR, Wani MA, Bhat MH. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column-Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract 2016;7:381-91.
] [Full text]
Arora RK, Kumar R. Spinal tumors: Trends from Northern India. Asian J Neurosurg 2015;10:291-7.
] [Full text]
Traul DE, Shaffrey ME, Schiff D. Part I: Spinal-cord neoplasms–intradural neoplasms. The Lancet Oncology 2007;8:35-45.
McCormick PC. Surgical management of dumbbell tumors of the cervical spine. Neurosurgery 1996;38:294-300.
Levy WJ, Latchaw J, Hahn JF, Sawhny B, Bay J, Dohn DF. Spinal neurofibromas: A report of 66 cases and a comparison with meningiomas. Neurosurgery 1986;18:331-4.
Levy WJ Jr., Bay J, Dohn D. Spinal cord meningioma. J Neurosurg 1982;57:804-12.
Lakshmi SS. Meningiomas: A clinicopathological study. Int J Med Res Health Sci 2015;4:827-37.
Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE. Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 2003;98(3 Suppl):258-63. doi: 10.3171/spi.2003.98.3.0258. PMID: 12691381.
Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF. Intraspinal meningiomas: Review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 1996;46:458-63.
[Table 1], [Table 2]