Surgical, SRS and Conventional Radiotherapy Outcomes in Primary Spinal Paragangliomas - A Systematic Review of 513 Patients

Introduction: Primary spinal paragangliomas are rare neuroendocrine tumors arising from paraganglia along the spine. Given the significant morbidity associated with these tumors, understanding treatment outcomes is essential. This systematic review assessed the impact of surgical and radiotherapeutic modalities on overall survival and neurological improvement.

Methods: This systematic review adhered to PRISMA guidelines. We conducted a comprehensive search of PubMed, EMBASE, and Web of Science from inception to October 2024 using key terms relevant to primary spinal paragangliomas. Rayyan AI was employed for screening and data extraction. We included studies evaluating surgery, stereotactic radiosurgery, and conventional radiotherapy, and excluded studies focusing on extra-spinal or metastatic paragangliomas. Data on procedural metrics and outcomes were extracted, and study quality was evaluated using the Joanna Briggs Institute tool. Statistical analyses were performed in Microsoft Excel and JMP, using Wilcoxon and Kruskal-Wallis tests for skewed distributions.

Results: Our analysis included 513 patients diagnosed with primary spinal paragangliomas. The mean age of patients was 45.85 years (SD = 14.40). Tumor distribution was predominantly lumbar (44%), with thoracic (24%), cervical (16%), and sacral (16%) regions also affected. The comparison of OS rates across treatment modalities revealed that surgical intervention was associated with significantly improved survival outcomes compared to non-surgical treatments, as indicated by the Wilcoxon Two-Sample Test (p = 0.0471) and supported by the Kruskal-Wallis Test (p = 0.0386). These findings underscore the benefit of surgical treatment for primary spinal paragangliomas.

Conclusion : This review highlights the superiority of surgical management over non-surgical approaches in improving survival outcomes for primary spinal paraganglioma patients. The significant variance in outcomes based on anatomical location further emphasizes the need for individualized treatment planning. Future research should continue to explore optimal strategies and refine the management guidelines for this rare but impactful condition.