Minimally invasive surgery outcomes for intradural extramedullary tumors: a systematic review and meta-analysis

Introduction: Traditionally, spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery which involves significant tissue dissection, prolonged time of surgery and painful recovery. Advanced techniques of minimally invasive surgery (MIS) aim to reduce these risks and complications while achieving similar goals of surgery. Objectives: To evaluate and compare surgical, functional, and complication-related outcomes in patients with ID-EM spine tumors receiving surgery through open approaches and MIS. Methods: Following PRISMA guidelines and registered under PROSPERO (#CRD42022302574), a systematic literature search was conducted across PubMed, EBSCO, and the Cochrane Library. Eligible studies included retrospective cohorts and case series that provided comparative data on MIS and open surgical approaches for IDEM tumor excision. Meta-analysis utilized the Mantel-Haenszel random-effects model for pooled data. Results: We reviewed 426 articles and included 16 for qualitative and quantitative analysis. On meta-analysis, a total of 804 patients (372 MIS and 432 open surgery) were included. MIS showed a significant reduction in operative time, intraoperative blood loss, and length of hospital stay. Gross total resection rates were comparable between the two approaches. MIS also resulted in fewer postoperative complications, including cerebrospinal fluid leaks and the need for spinal fusion. Conclusion: MIS for IDEM tumors provides surgical and recovery benefits compared to traditional open surgery, including shorter operative times, reduced blood loss, and fewer postoperative complications. Although both methods achieve similar tumor resection rates, MIS is linked to enhanced patient outcomes and shorter hospital stays, underscoring its role as a viable alternative in managing IDEM tumors. Future research should aim to optimize MIS techniques to improve patient safety and outcomes further.