Spinal Intradural Extramedullary Nerve Sheath Tumors and Meningiomas: Surgical Management and Outcome

Objective: This study was done on 40 patients having extramedullary cord tumor (nerve sheath tumor and meningiomas) to evaluate the clinical presentation, investigation, surgery, post-operative outcome and recurrence. Patients: This study was carried out on 40 patients having diagnosis of spinal nerve sheath tumors or meningiomas and treated in the period between 1999 and 2005. The medical records of patients, such as their clinical presentations, neuroradiological findings, operative reports, functional outcome, complications and recurrence, were evaluated. The average age of these 40 patients was 38±13 years. Female sex predominated slightly in meningiomas while male sex slightly predominated in nerve sheath tumors. Results: The average duration of symptoms until admission for surgery was significantly shorter for patients with nerve sheath tumors (22.1±23 months) than for patients with meningiomas (25±15 months). Complete tumor removal was achieved in 60% of the patients; 74.1% in nerve sheath tumors and 30.8% in meningiomas. Resection of a clinically relevant nerve root was done in 14 cases of nerve sheath tumors; 2 (14.3%) in the cervical, 5 (35.7%) in the thoracic and 7 (50.0%) in the lumbar regions. Post-operative complications occurred were CSF leakage in 7 cases (25.9%) of nerve sheath tumors and in 4 cases (30.8%) of meningiomas, while wound infection was observed in 1 patient (3.7%) of nerve sheath tumors and 2 patients (15.4%) of meningiomas. Conclusion: Early diagnosis and surgery is the preferred management in cases of spinal nerve sheath tumors and meningiomas due to its associated excellent functional improvement and low recurrence rates. Surgical transsection of the nerve root carrying nerve sheath tumors will lead to radical removal and less incidence of recurrence; but this must be weighed against the risk of spinal cord damage.