Title : Comparative analysis of open vs. MIS intradural surgery- hybrid open/MIS surgeons
Abstract:
Introduction: Intradural tumours are rare and surgically challenging due to their proximity to critical neural structures. Conventional open surgery has long been the standard approach; however, minimally invasive surgery (MIS) techniques have emerged as an alternative approach aiming to reduce tissue trauma, blood loss, and postoperative recovery time. Existing literature comparing open and MIS approaches remains limited, particularly regarding postoperative neurological outcomes. This study addresses this gap by providing a comparative analysis of both approaches in a single-centre cohort.
Objective: To evaluate the perioperative outcomes, neurological complications, and safety profile of open versus MIS intradural tumour resections, and to evaluate the feasibility of MIS in approaching selected patients.
Methods: This retrospective cohort study included consecutive patients undergoing intradural tumour resection at a single tertiary centre between 01/01/2020 and 10/12/2025. Patients were stratified according to surgical approach into open surgery (n = 109) and MIS (n = 22) groups. Collected variables included patient demographics, comorbidities, tumour characteristics (spinal level, size, histology, and WHO grade), intraoperative variables (estimated blood loss, operative time, and extent of resection), and postoperative outcomes (length of stay, analgesia requirements, complications, neurological deficits, and readmissions). Outcomes were compared between groups using appropriate comparative analyses.
Results: Patients undergoing MIS demonstrated lower estimated blood loss (p=0.049), shorter operative times (p=0.029), and reduced length of hospital stay (p=0.029) compared with those undergoing open surgery. New or worsened postoperative neurological deficits were observed more frequently in the open surgery group (p=0.017). Overall postoperative complication rates and hospital readmissions were low and comparable between both surgical approaches. Open surgery was more commonly used for larger, higher-grade, or anatomically complex tumours.
Conclusion: In selected patients, MIS provides clear advantages, including reduced intraoperative morbidity and faster recovery, while maintaining safety comparable to open surgery. These findings support the preferential use of MIS when technically feasible, highlighting its potential to improve perioperative outcomes and patient quality of life.
