Efficacy and Safety of Minimally Invasive Surgery vs. Open Techniques in the Resection of Intradural Extramedullary Tumors: Systematic Review and Meta-Analysis

Background: Minimally invasive surgery (MIS) has emerged as an alternative for the resection of Intradural extramedullary (IDEM) tumors compared to open surgical techniques due to its potential to reduce tissue trauma and accelerate patient recovery. This study aims to evaluate the safety and efficacy of MIS in the management of IDEM tumors in comparison to open surgical techniques. Methods: The authors conducted a systematic review of the PubMed, ScienceDirect, and Cochrane Library databases up to June 2025, following PRISMA guidelines. Relevant keywords were used to search for studies comparing MIS and open surgical techniques for the treatment of IDEM tumors. Outcomes were categorized into primary clinical outcomes and postoperative recovery and symptom outcomes. Results: The study included 12 comparative studies, involving a total of 692 IDEM patients; 338 had MIS vs. 354 undergoing open surgery. Meta-analysis revealed that MIS resulted in significantly lower estimated blood loss (MD: −217.85 mL; P < 0.00001), shorter operative time (MD: −58.25 minutes; P = 0.006), and reduced hospital stay (MD: −2.98 days; P < 0.00001) compared to open surgery, with comparable gross total resection rates (P = 0.38). MIS also demonstrated superior pain reduction at 1 month postoperatively (visual analog scale (VAS) MD: −1.68; P < 0.00001), though recurrence rates, 3-month pain scores, American Spinal Injury Association Score (ASIA) scores, and symptom relief were similar between groups (P > 0.05). Conclusion: MIS for IDEM tumors offers significant advantages over open surgery, including reduced blood loss, shorter operative time, and faster hospitalization, without compromising resection completeness. While early postoperative pain relief was superior with MIS, long-term functional outcomes and recurrence rates were comparable between approaches. These findings support MIS as a safe and effective alternative for IDEM tumor resection, though surgeon expertise and patient selection remain critical.