Factors influencing the development of recurrence and continued growth of primary extramedullary tumors removed using Nd:YAG laser

Objective. To assess the significance of clinical factors of extramedullary tumors and new methods of their resection as potential predictors of their recurrence and continued growth.

Material and Methods. The long-term results of removal of primary extramedullary tumors in 412 patients operated on in 1998–2014 were analyzed comparing the use of standard methods of microsurgical technique for tumor removal (277 patients) and of those with additional use of neodymium laser radiation (135 patients).

Results. The use of laser technologies for resection of extramedullary tumors can significantly reduce the number of their recurrences and continued growth, along with other clinical factors is a significant prognostic indicator in determining the nature of the disease course and can be a predictor of their occurrence. The most reliable clinical factors determining the prognosis of a decrease in the incidence of recurrences and continued growth when using laser techniques of surgical resection were repeated operations (p = 0.002), the presence of ependymomas of the cone and cauda equina (p = 0.017), operations for primary tumors in the thoracic spine (p = 0.039) and extramedullary tumors with Grade I anaplasia (p = 0.007). An increase in the number of these conditions was associated with operations on the cervical spine (p = 0.027), the presence of a tumor with Grade II anaplasia (p = 0.007), and a primary extramedullary tumor involving more than three vertebrae (p = 0.017).

Conclusion. The use of the laser is indicated for reoperations when removing neoplasms, that have arisen as a result of recurrence or continued growth of extramedullary tumors of any level and length after removal of primary neoplasms with a Grade I malignancy confirmed by intraoperative cytological examination involving no more than three vertebrae in the thoracic, lumbar and sacral spine and during resection of ependymomas with extramedullary 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. 96–103. [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):96–103. In Russian]. DOI: 10.15690/vramn 945.

2. Koeller KK, Shih RY. Iintradural extramedullary spinal neoplasms: radiologic-pathologic correlation. Radiographics. 2019;39:468–490. DOI: 10.1148/rg.2019180200.

3. Бывальцев В.А., Сороковиков В.А., Дамдинов В.В., Белых Е.Г., Середа Е.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 BB, Belykh EG, Sereda EV, Panasenkov SYu, Grigor’ev EG. Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study. Zh Vopr Neirokhir Im N.N. Burdenko. 2014;78(6):15–23. In Russian.] DOI: 10.17116/neiro201478615-23.

4. 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.

5. Бекяшев А.Х. Патогенез менингиом (обзор литературы) // Опухоли головы и шеи. 2011. № 4. С. 26–40. [Bekyashev AKh. Pathogenesis of meningiomas (literature review). Opukholi golovy i shei. 2011;4:26–40. In Russian].

6. Fehlings MG, Nater A, Zamorano JJ, Tetreault LA, Varga PP, Gokaslan ZL, Boriani S, Fisher CG, Rhines L, Bettegowda C, Kawahara N, Chou D. Risk Factors for recurrence of surgically treated conventional spinal schwannomas: analysis of 169 patients from a multicenter international database. Spine. 2016;41:390–398. DOI: 10.1097/BRS.0000000000001232.

7. Евзиков Г.Ю., Фомичев В.Г. Хирургическое лечение интрадуральных экстрамедуллярных спинальных опухолей // Нейрохирургия. 2004. № 2. С. 3–6. [Evzikov GYu, Fomichev VG. Surgical treatment of intradural extramedullary spinal tumors. Russian Journal of Neurosurgery. Neyrokhirurgiya. 2004;2:3–6. In Russian].

8. 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].

9. Коновалов Н.А., Шевелев И.Н., Назаренко А.Г., Асютин Д.С., Королишин В.А., Тимонин С.Ю., 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, Asyutin DS, Korolishin VA, Timonin SYu, Zakirov BA, Onoprienko RA. The use of minimally invasive approaches to resect intradural extramedullary spinal cord tumors. Zh Vopr Neyrokhir Im N N Burdenko. 2014;78(6):24–36. In Russian].

10. 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:

11. –77. In Russian].

12. 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.

13. 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.

14. 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.

15. 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.

16. Iacoangeli M, Gladi M, Di Rienzo A, Dobran M, Alvaro L, Nocchi N, Maria LG, Somma D, Colasanti R, Scerrati M. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature. Clin Interv Aging 2012;7:557–564. DOI: 10.2147/CIA.S38923.