Objective. The aim of this study was to evaluate clinical characteristics, surgical outcomes, and factors influencing postoperative neurological status in patients undergoing resection of intradural spinal tumors, with particular emphasis on the role of preoperative neurological function and intraoperative neuromonitoring (IONM). Methods. We conducted a retrospective analysis of 108 patients who underwent surgical resection of intradural spinal tumors at a single neurosurgical center. Patients were categorized into intradural extramedullary (IDEM) and intramedullary (IM) tumor groups. The primary endpoint was the occurrence of a new or worsened postoperative motor deficit at discharge. Secondary endpoints included postoperative sphincter dysfunction and functional status assessed using the modified McCormick scale at discharge and at 6-month follow-up. Categorical variables were compared using the Chi-square or Fisher’s exact test, and continuous variables using the Mann–Whitney U test. Results. A total of 108 patients were included (61.1% female; mean age 55.7 ± 15.6 years). IDEM tumors accounted for 77 cases, while 31 were intramedullary. There were no significant differences between IDEM and IM tumors in the rate of new or worsened postoperative motor deficits (9.1% vs. 6.7%, p = 1.000), postoperative sphincter dysfunction (2.6% vs. 0%, p = 1.000), or functional outcomes assessed using the modified McCormick scale at discharge (p = 0.85) and at 6 months (p = 0.24). Preoperative motor deficit was strongly associated with postoperative motor dysfunction in the overall cohort (86% vs. 14%, p < 0.001), with an even stronger effect observed in the IM subgroup (90.9% vs. 9.1%, p < 0.001). IONM was used in 34.3% of cases and was significantly associated with tumor location, histopathology, and surgical complexity. However, IONM use was not associated with postoperative motor outcomes (p = 0.645). Conclusions. Postoperative neurological outcomes following intradural spinal tumor resection are comparable between intramedullary and extramedullary lesions. Preoperative motor deficit is the strongest predictor of postoperative neurological status, particularly in intramedullary tumors, underscoring the importance of early surgical intervention. IONM is preferentially used in higher-risk cases and should be interpreted as a marker of surgical complexity rather than an independent determinant of outcomes.
Krzemińska et al. (Sun,) studied this question.