Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.

Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.

Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).

Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

1. Бывальцев В.А., Степанов И.А., Белых Е.Г., Алиев М.А. Анализ отдаленных результатов хирургического лечения пациентов с интрадуральными опухолями спинного мозга // Вестник РАМН. 2018. Т. 73. № 2. С. 88–95. [Byvaltsev VA, Stepanov IA, Belykh EG, Aliyev MA. Long-term results of surgical treatment in patients with intradural spinal tumors. Annals of the Russian Academy of Medical Sciences (Vestnik Rossiiskoi akademii meditsinskikh nauk). 2018;73(2):88–95. In Russian]. DOI: 10.15690/vramn945.

2. Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci. 2009;9 Suppl. 1:S40–45. DOI: 10.17305/bjbms.2009.2755.

3. Cofano F, Giambra C, Costa P, Zeppa P, Bianconi A, Mammi M, Monticelli M, Di Perna G, Junemann CV, Melcarne A, Massaro F, Ducati A, Tartara F, Zenga F, Garbossa D. Management of extramedullary intradural spinal tumors: the impact of clinical status, intraoperative neurophysiological monitoring and surgical approach on outcomes in a 12-year double-center experience. Front Neurol. 2020;11:598619. DOI: 10.3389/fneur.2020.598619.

4. Van der Wal EC, Klimek M, Rijs K, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative neuromonitoring in patients with intradural extramedullary spinal cord tumor: a single-center case series. World Neurosurg. 2021;147:e516–e523. DOI: 10.1016/j.wneu.2020.12.099.

5. Sudhan MD, Satyarthee GD, Joseph L, Kakkar A, Sharma MC. Primary intradural extramedullary lesions: a longitudinal study of 212 patients and analysis of predictors of functional outcome. J Neurosurg Sci. 2020 Dec 9. DOI: 10.23736/S0390-5616.20.05147

6. Бывальцев В.А., Сороковиков В.А., Дамдинов В.В., Белых Е.Г., Середа Э.В., Панасенков С.Ю., Григорьев Е.Г. Факторы, влияющие на исход хирургического лечения экстрамедуллярных опухолей спинного мозга: мультицентровое исследование // Вопросы нейрохирургии им. Н.Н. Бурденко. 2014. Т. 78. № 6. С. 15–23. [Byval’tsev VA, Sorokovikov VA, Damdinov VV, Belykh EG, Sereda EV, Panasenkov SYu, Grigor’iev EG. Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study. Zhurnal Voprosy neyrokhirurgii imeni N.N. Burdenko. 2014;78(6):15–23. In Russian]. DOI: 10.17116/neiro201478615-23.

7. Aghayev K, Vrionis F, Chamberlain MC. Adult intradural primary spinal cord tumors. J Natl Compr Canc Netw. 2011;9:434–447. DOI: 10.6004/jnccn.2011.0039.

8. Бекяшев А.Х. Патогенез менингиом (обзор литературы) // Опухоли головы и шеи. 2011. № 4. С. 26–40. [Bekyashev AKh. Pathogenesis of meningiomas (a review of literature). Head and Neck Tumors (HNT). 2011;(4):26–40. In Russian].

9. Houten JK, Cooper PR. Spinal cord astrocytomas: presentation, management and outcome. J Neurooncol. 2000;47:219–224. DOI: 10.1023/a:1006466422143.

10. Ступак В.В., Шабанов С.В., Пендюрин И.В., Цветовский С.Б., Окладников Г.И., Рабинович С.С., Долженко Д.А. Эпендимомы пояснично-крестцовой области. Собственные результаты хирургического лечения // Успехи современного естествознания. 2015. № 5. С. 38–44. [Stupak VV, Shabanov SV, Pendyurin IV, Tsvetovsky SB, Okladnikov GI, Rabinovich SS, Dolzhenko DA. Ependymomas of lumbosacral localization. Long term results of surgical treatment. Advances in Current Natural Sciences. 2015;(5):38–44. In Russian].

11. Коновалов Н.А., Шевелев И.Н., Назаренко А.Г., Асютин Д.С., Королишин В.А., Тимонин С.И., Закиров Б.А., Оноприенко Р.А. Применение минимально инвазивных доступов для удаления интрадуральных экстрамедуллярных опухолей спинного мозга // Вопросы нейрохирургии им. Н.Н. Бурденко. 2014. Т. 78. № 6. С. 24–36. [Konovalov NA, Shevelev IN, Nazarenko AG, Asiutin DS, Korolishin VA, Timonin SIu, Zakirov BA, Onoprienko RA. The use of minimally invasive approaches to resect intradural extramedullary spinal cord tumors. Zhurnal Voprosy neyrokhirurgii imeni N.N. Burdenko. 2014;78(6):24–36. In Russian].

12. Ступак В.В., Моисеев В.В. Nd-YAG-лазер в хирургии экстрамедуллярных опухолей // Хирургия позвоночника. 2004. № 1. С. 71–77. [Stupak VV, Moiseev VV. ND-YAG laser in extramedullary tumor surgery. Hir. Pozvonoc. 2004;(1):71–77. In Russian].

13. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. DOI: 10.1007/s00401-007-0243-4.

14. Turel MK, D’Souza WP, Rajshekhar V. Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients. Neurosurg Focus. 2015;39:E9. DOI: 10.3171/2015.5.FOCUS15170.

15. Kwee LE, Harhangi BS, Ponne GA, Kros JM, Dirven CMF, Dammers R. Spinal meningiomas: Treatment outcome and long-term follow-up. Clin Neurol Neurosurg. 2020;198:106238. DOI: 10.1016/j.clineuro.2020.106238.

16. Wong AP, Lall RR, Dahdaleh NS, Lawton CD, Smith ZA, Wong RH, Harvey MJ, Lam S, Koski TR, Fessler RG. Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors. Neurosurg Focus. 2015;39:E11. DOI: 10.3171/2015.5.FOCUS15129.

17. Hirano K, Imagama S, Sato K, Kato F, Yukawa Y, Yoshihara H, Kamiya M, Deguchi M, Kanemura T, Matsubara Y, Inoh H, Kawakami N, Takatsu T, Ito Z, Wakao N, Ando K, Tauchi R, Muramoto A, Matsuyama Y, Ishiguro N. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J. 2012;21:2019–2026. DOI: 10.1007/s00586-012-2345-5.

18. Helseth A, Mork SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg. 1989;71:842–845. DOI: 10.3171/jns.1989.71.6.0842.

19. Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol. 1999;52:552–562. DOI: 10.1016/S0090-3019(99)00153-6.

20. Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F. Spinal meningiomas: review of 174 operated cases. Neurosurgery. 1989;25:153–160. DOI: 10.1227/00006123-198908000-00001.

21. Baumgartner JE, Sorenson JM. Meningioma in the pediatric population. J Neurooncol. 1996;29:223–228. DOI: 10.1007/BF00165652.

22. Crone KR, Challa VR, Kute TE, Moody DM, Kelly DL Jr. Relationship between flow cytometric features and clinical behavior of meningiomas. Neurosurgery. 1988;23:

23. –724. DOI: 10.1227/00006123-198812000-00006.

24. Borovich B, Doron Y. Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg. 1986;64:58–63. DOI: 10.3171/jns.1986.64.1.0058.

25. Mariniello G, Spaziante R, Cappabianca P, Donzelli R, Del Basso de Caro ML, De Divitiis E. Multicentrical growth of meningiomas: «spatial» or «temporal» phenomenon. J Neurosurg Sci. 1995;39:241–247.