Spinal Tumor Excision
At The Brain and Spine Centre, we specialize in the diagnosis and surgical treatment of neurological and spinal disorders. Dr. Muhammad Aqeel Natt, a leading neurosurgeon in Lahore, provides advanced, safe, and compassionate care for patients.
Spinal Tumor Excision
Spinal tumor excision is a microsurgical procedure to remove benign or malignant tumours of the spine and spinal cord, aiming to decompress neural structures, relieve pain and neurological deficits, achieve complete or near-complete tumour removal, and preserve or restore spinal function. At The Brain and Spine Centre, Dr. Muhammad Aqeel Natt offers specialised microsurgical spinal tumour resection at Farooq Hospital, West Wood Branch, Lahore, using advanced neuroimaging, intraoperative neuromonitoring, and meticulous technique to maximise tumour removal while protecting neurological function.
Our goal is simple: safely remove the tumour, relieve cord and nerve compression, achieve durable local control, and restore the best possible spinal function and quality of life.
What Are Spinal Tumours?
Spinal tumours are abnormal growths arising from spine and spinal cord structures. They are classified by location:
Extradural tumours: outside the dura (spinal fluid membrane); include metastatic cancer, lymphoma, vertebral body tumours, and bone lesions.
Intradural extramedullary (IDEM) tumours: inside dura but outside spinal cord; mostly benign (schwannoma ~46%, meningioma ~20%, neurofibroma); have the best surgical prognosis.
Intramedullary (IM) tumours: within the spinal cord; include ependymoma, astrocytoma, hemangioblastoma, and syrinx-associated tumours; technically more challenging.
Symptoms of Spinal Tumours
Symptoms evolve gradually as tumours grow and compress neural structures.
Common features:
Progressive back or neck pain, often worse at night, radiating into arms or legs; pain from bone destruction or nerve irritation.
Radicular pain (sharp, shooting pain down arm or leg) from nerve root compression.
Weakness or numbness in limbs, progressive over weeks to months, sometimes rapidly if bleeding occurs.
Gait disturbance, loss of coordination, difficulty walking, and in severe cases, paraplegia (leg paralysis) or quadriplegia (all-limb paralysis).
Bladder or bowel dysfunction: loss of continence or difficulty with urination, a sign of cord compression requiring urgent surgery.
Myelopathy symptoms: progressive difficulty with fine motor tasks (buttoning, writing), stiffness, loss of dexterity from cord ischemia or compression.
Early diagnosis is critical because prolonged cord compression can cause irreversible neurological damage.
Diagnosis
Precise imaging and sometimes biopsy confirm diagnosis and guide surgical planning.
MRI is the gold standard; it shows tumour size, location (extradural/IDEM/IM), cord compression, syrinx, and spinal alignment; T1, T2, T2-FLAIR, diffusion, and post-contrast sequences characterise lesion.
CT shows bony involvement, destruction, and structural details; CT-guided biopsy can obtain tissue diagnosis.
Pre-operative assessment: McCormick grade (neurological severity scale) predicts postoperative recovery; grade 1–3 have better prognosis than grades 4–5.
Treatment Options
Observation: asymptomatic, small, stable tumours may be monitored with serial MRI.
Surgical excision is indicated for:
Symptomatic tumours with progressive neurological deficits, myelopathy, or pain.
Cord compression or mass effect on imaging.
Growing tumours or tumours with risk of instability.
Diagnostic uncertainty requiring tissue diagnosis.
Surgical approaches depend on tumour location:
Extradural tumours: laminectomy and direct exposure; anterior, posterior, or lateral approaches depending on location.
IDEM tumours: laminotomy/laminectomy; dura opened; gentle dissection along pial margin away from spinal cord.
Intramedullary tumours: laminotomy, dural opening, and ultramicrosurgical intraparenchymal dissection; requires intraoperative neuromonitoring.
Stabilization: if resection compromises spinal stability, instrumentation with screws, rods, and bone graft are used.
Adjuvant therapy: radiotherapy (and sometimes chemotherapy) for malignant tumours, or for incomplete resections.
The Procedure
At The Brain and Spine Centre:
Preoperative planning: detailed MRI defines tumour extent, cord signal changes, and safest surgical approach.
Intraoperative neuromonitoring: somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) monitor cord function continuously during resection.
Microsurgical resection:
Small, precise incision based on tumour location (often laminotomy rather than full laminectomy).
Gentle tumour dissection along pial margins, avoiding adherent normal tissue.
Gross total resection (GTR) is the goal for most benign tumours; subtotal resection may be necessary to preserve function in infiltrative malignancies.
Reconstruction: dural closure, stabilization if needed, careful soft-tissue closure to prevent CSF leak.
Recovery & Aftercare
Recovery varies by tumour type, location, and extent of resection.
Hospital stay: typically 3–7 days for uncomplicated resections.
Neurological recovery: may begin immediately post-operatively or gradually over days to months.
Patients with preoperative deficits often improve; ~55–71% show neurological improvement at follow-up.
Patients with new postoperative deficits frequently recover, especially those without preoperative symptoms (~all recovered within 3 months in one series).
Physiotherapy: early mobilisation, strengthening, and gait training support recovery.
Long-term follow-up: serial MRI at 3, 6, 12 months to monitor for recurrence or progression; adjuvant radiotherapy may follow if indicated.
Results You Can Expect
Outcomes depend on tumour type, location, preoperative status, and extent of resection.
Extradural tumours: best prognosis; ~90% achieve good functional outcome (Grades 1–3 McCormick); improvement rates 4.7× better than intramedullary tumours.
IDEM tumours: excellent prognosis; gross total resection ~70–100% with intraoperative monitoring; >90% mobile at follow-up.
Intramedullary tumours: more challenging; GTR ~70%, with improvement rates ~2× vs baseline.
Complications:
New postoperative neurological deficits: ~9–37% (varies by series); most recover within months.
CSF leak: ~5%; usually managed conservatively.
Persistent pain: ~10–15%; usually manageable with medications and rehabilitation.
Recurrence/progression‑free survival: ~80% at long-term follow-up with adequate resection and adjuvant therapy when indicated.
Why Choose The Brain and Spine Centre
Led by Dr. Muhammad Aqeel Natt, with extensive expertise in intramedullary and extramedullary spinal tumour microsurgery and neuro-oncology. Access to high-field MRI for detailed tumour characterisation and surgical planning. Intraoperative neuromonitoring (SSEP/MEP) to preserve neurological function during resection and maximise extent of safe resection. Minimally invasive approaches where possible (laminotomy vs laminectomy) to reduce morbidity and promote faster recovery. Integrated multidisciplinary care with oncology, rehabilitation, and long-term surveillance to optimise recurrence control and functional outcomes.
Cost of Spinal Tumour Excision
Costs vary with tumour complexity, location, need for instrumentation, ICU stay, intraoperative monitoring, and adjuvant radiotherapy. Detailed cost estimates are provided after imaging and clinical assessment.
