Intradural Extramedullary Spinal Tumors

Intradural extramedullary spinal tumors (ID-EMTs) are more common neoplasms (up to 40% of spinal tumors), usually benign in nature and most frequently meningiomas and nerve sheath tumors (schwannomas and neurofibromas) with highest incidence in patients affected by neurofibromatosis, both NF1 and NF2. Radical surgery with intraoperative neurophysiology monitoring is the gold-standard treatment and is the most important prognostic factor both for functional outcome and survival. Methods: We performed a 14-year prospective analysis of a large group of patients, harboring ID-EMTs, surgically treated at our institution and reviewed, in comparison, the major surgical series in literature. Results: In our series, 105 patients harboring ID-EMTs were treated; 32 meningiomas, 68 schwannomas and 5 neurofibromas. Gross total resection was achieved in 96.9% of patients. No clinical worsening was observed after surgical resection at a mean follow up of 48 months. Conclusions: Surgery via laminectomy or laminotomy with laminoplasty is the treatment of choice for ID-EMTs. Vertebral fusion techniques or multiple approaches can be required when the patient presents with large extraforaminal lesions. In patients with multiple tumors in the context of NF, surgery is considered only when neurological deficits are present.