Systematic Review Comparing Open Versus Minimally Invasive Surgical Management of Intradural Extramedullary Tumours (IDEM)

Background/Objectives: Intradural extramedullary (IDEM) spinal tumours are relatively rare and predominantly benign. Gross total resection (GTR) has been demonstrated as an effective treatment, with increasing evidence supporting the use of minimally invasive techniques to achieve GTR. This study reviews the current surgical management options for IDEM tumours and their outcomes. Methods: A systematic literature search without meta-analysis was conducted by two independent reviewers in December 2024. The population of interest comprised patients who underwent surgical treatment for IDEM tumours. Outcomes assessed included the extent of resection, postoperative neurological function, and complications. Results: Fifty-seven articles met the inclusion criteria, providing data on 4695 IDEM cases, of which 3495 were managed through open surgery and 750 via minimally invasive surgery. The extent of resection was high, with a mean GTR > 90% across studies. Open laminectomy and unilateral minimally invasive hemilaminectomy were the most common surgical approaches. Complications, such as cerebrospinal fluid leaks, were less frequent following minimally invasive procedures vs. open surgery (11.1% vs. 14.3%). Minimally invasive surgery also led to improved postoperative functional outcomes (mean McCormick score change -1.30 vs. -0.64) and a lower recurrence rate (1.4% vs. 10.0%). Conclusions: Whilst open surgery yields acceptable rates of resection and neurological improvement, there is growing evidence that minimally invasive surgery can achieve comparable, if not superior, rates of resection with fewer complications, leading to lower costs and shorter hospital stays.