Management and Surgical Outcomes of adult spinal Intradural lesions: A retrospective study.

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Objective: Spinal intradural lesions (IDLs) range from benign lesions to lethal malignant tumours.Approaches to treat the spinal lesions depend on their nature.This study aims to summarise our approach and strategies in treating IDLs by evaluating the surgical outcomes of 53 consecutively operated patients. Materials and Methods:We retrospectively reviewed the medical records of 53 patients with spinal IDLs who underwent surgery at our institute spanning 6 years, from January 1992 to December 1997.The long-term surgical outcomes were evaluated.Based on the relevant literature, our surgical approaches and strategies were discussed.Results: Overall, 53 cases were enrolled, 25 women and 28 men.The mean age was 52.2±18.4years.The most common symptom was radicular pain (88.7%).Histopathologic diagnoses were meningioma (n=16), schwannoma (n=11), ependymoma (n=9), astrocytoma (n=6), lipoma (n=3) and other pathologies in eight cases.Gross-total (GTR), near-total (NTR) and subtotal (STR) resections were achieved in 34, six and 13 patients, respectively.Although 45 (84.9%) patients underwent total laminectomy, only one patient underwent fixation with posterior instrumentation after GTR 13 years later, when he presented with the progression of subtotally resected schwannoma.Intramedullary location was an independent factor to perform STR instead of GTR or NTR (p=0.032). Conclusion:The treatment approach for IDLs depends on several factors, such as the patient's age, estimated survival, the nature of the lesion and the presenting symptoms.Based on the need for postoperative posterior fixation, we did not observed a statistical difference supporting the superiority of hemilaminectomy over total laminectomy.Nevertheless, further large, prospective studies are needed to support our findings.