Introduction: Intradural extramedullary (IDEM) schwannomas are slow-growing tumors arising from the nerve sheaths in the spine. Standard treatment involves surgical resection, typically via laminectomy. However, with a growing interest in minimally invasive procedures, hemilaminectomy has emerged as an effective alternative in approaching these tumors. To assess the efficacy and safety of both techniques, we conducted a meta-analysis comparing their outcomes.
Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials and observational studies comparing laminectomy with hemilaminectomy for surgical resection of IDEM schwannoma. The outcomes assessed included length of hospital stay, intraoperative blood loss, operative time, Visual Analog Scale (VAS) scores, and postoperative complication rate. Meta-analysis was performed using a random-effects model.
Results: Three studies were eligible for inclusion, comprising 160 patients, of whom 79 (49.4%) underwent laminectomy and 81 (51.6%) received hemilaminectomy. Hemilaminectomy was not able to significantly reduce the length of hospital stay (MD 3.00; 95% CI -0.02, 6.01; p=0.05; I²=69%) and intraoperative blood loss (MD 79.44; 95% CI -126.56, 285.45; p=0.45; I²=67%) in comparison with laminectomy. However, hemilaminectomy was associated with a significantly decreased operative time (MD 66.83; 95% CI 27.56, 106.09; p=0.0009; I²=62%). There was no significant difference between groups in VAS score (MD 1.00; 95% CI -1.06, 3.05; p=0.34; I²=94%) and complication rate (OR 4.21; 95% CI 0.85, 20.83; p=0.08; I²=0%).
Conclusion : In this meta-analysis, hemilaminectomy was associated with a significantly shorter operative time compared with laminectomy, although no significant differences were observed between the two procedures in terms of hospitalization time, intraoperative blood loss, pain, and complication rate. Further research is needed to explore other potential benefits of hemilaminectomy and to better define its long-term outcomes in this patient population.
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