The Impact of Expansile Duraplasty After Resection of Intramedullary Astrocytomas

Intramedullary spinal cord tumors are rare and often difficult to resect due to infiltration of the cord parenchyma. Surgeons may elect to perform an expansile duraplasty after resection, although the impact of duraplasty on postoperative outcomes has not been well-characterized. Therefore, we examine the characteristics and outcomes of patients receiving duraplasty after resection of intramedullary astrocytomas.

Adult patients undergoing surgical resection of a primary spinal cord astrocytoma between 2003 and 2023 at a single tertiary care hospital were retrospectively identified. Cohort characteristics were collected from patient charts. Data were analyzed using the Wilcoxon rank-sum and Fisher exact tests. Multivariable analyses investigated the impact of duraplasty on postoperative outcomes. Subgroup analyses were performed on patients who underwent subtotal resection and on a propensity score matched cohort based on age and body mass index.

Fifty-nine patients were identified, with 14 (24%) receiving expansile duraplasty. Patients with duraplasty were more likely to experience longer hospitalizations (median 9 vs 5 days; P < .01), undergo subtotal resection (100% vs 60%; P < .01), and be discharged to acute care inpatient rehabilitation (79% vs 40%; P = .02). They had higher rates of chemotherapy (71% vs 31%; P = .01), cerebrospinal fluid leaks (21% vs 2%; P = .04), worse functional outcomes at last follow-up (71% vs 42% modified McCormick scale > 2; P = .05), and mortality at last follow-up (79% vs 27%; P < .01) than those without duraplasty.

Currently, duraplasty remains an option based on surgeon judgment, typically in situations when intraoperative swelling occurs, dural closure is not possible, or postoperative cord or tumor expansion is anticipated. With current patient selection practices, providers and patients should be aware of the differences often seen in the postoperative course and appropriately weigh the risks of added surgical complexity against the potential for meaningful improvements in patient quality of life and survival.