Minimally invasive approaches to intramedullary spinal cord tumors: a systematic review of techniques and outcomes

PURPOSE: To systematically review the published literature on minimally invasive spine surgery (MISS) approaches for intramedullary spinal cord tumor (IMSCT) resection and summarize surgical techniques, perioperative outcomes, neurological results, and complications. METHODS: A PRISMA-guided search of PubMed, CINAHL, Cochrane Trials, and Scopus was performed from inception through November 19, 2025. Studies reporting MISS techniques for IMSCT resection with operative details and perioperative outcomes were included. RESULTS: Out of a total of 482 studies identified, 11 were included that reported on a total of 222 patients (Age range: 11-72; 52.9% male population). 64% of included studies (n=7 of 11) were retrospective case series whereas 36% (n=4 of 11) were case reports. Posterior tubular retractor-based approaches were most commonly reported, with fewer studies describing non-tubular, muscle- and bone-preserving laminotomy techniques. Tumors most frequently involved the cervical (33.2%; n=74 of the 223 tumors), and thoracic spine segments (30.9%; n=69 of the 223 tumors). Ependymoma (41.3%; n=92 of the 223 tumors), astrocytoma (32.3%; n=72 of the 223 or tumors), and hemangioblastoma (16.6%; n=37 of the 223 or tumors) were the most common histologies. Estimated blood loss was reported in 7 of 11 studies (63.6%) and was uniformly low (under 200 mL); length of hospital stay was reported in 7 of 11 studies (63.6%) and was generally short (3 to 6 days); and extent of resection was reported in all included studies (11/11, 100%), with high rates of gross total resection (87.4%; n=195 of the 223 tumors). Postoperative neurological outcomes were most often stable or improved relative to baseline. Complications and recurrences were uncommon, though follow-up duration was variable. CONCLUSION: MISS approaches for IMSCT resection are feasible in select cases and can be performed using posterior muscle- and bone-sparing techniques, with generally minimal complications and stable or improved postoperative neurological function. Favorable outcomes likely reflect both technical advantages and selection of tumors with anatomical and histological characteristics suited to MISS. Such variables should be controlled for in future comparative studies.