Intramedullary Spinal Cord Metastases: Review of the Literature

Abstract

Aims. To review the epidemiology, dissemination, clinical presentation, diagnosis, treatment, survival and functional outcome of intramedullary spinal cord metastases (ISCM).Methods. Literature review of all surgically treated cases of ISCM and all described cases of ISCM of breast carcinoma.Results. 42 references to 87 surgically treated cases of ISCM were found, 13 references to 27 cases with diagnosed and treated ISCM of breast carcinoma. In only 9 cases of spinal cord metastases of breast cancer was surgical resection of ISCM done (10% of all surgically treated ISCM).Conclusions. Three treatment modalities are available for ISCM: radiotherapy, chemotherapy, and surgery. The gold standard remains radiotherapy.Microsurgical resection of a focal intramedullary mass appears to be feasible and should be considered in selected cases. Patients who have no evidence of widespread organ metastases or multiple intramedullary lesions and who have a life expectancy of at least a few months with tumours of non-lymphoma histology should be considered for tumor resection.In conclusion, ISCM are difficult to treat lesions, but early diagnosis, careful surgical management and maintenance therapy may substantially contribute to a satisfactory functional outcome and prolonged survival.

Intramedullary Spinal Cord Metastasis of Bladder Carcinoma: A Case Report

“…In our patient, pain was the initial symptom and was followed by weakness of the extremities. Sudden onset of neurological deficit and rapid progression are the most consistent characteristics of ISCM and this is helpful in distinguishing it from the slow growing primary spinal intramedullary tumours [8,13]. The distribution of the weakness is asymmetric in most patients with ISCM, as it was in our patient and in one of the two other cases [8,12].…”

Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

“…9 Recent studies have described longer survival in patients undergoing surgery. 2,14,15 Dam-Hieu et al retrospective reviewed 19 patients with ISCMs. The 13 patients who received operation have longer survival compared with those who did not (7.4 months vs 2.6 months).…”

Intramedullary Spinal Cord Solitary Metastasis as the Inaugural Presentation of Colorectal Cancer: A Case Report

“…As MRI is highly sensitive and many patients have a poor performance status to undergo a neurosurgical intervention, we can go without histological analysis and assume ISCM diagnosis only by imaging [2]. Our patient had no indication for neurosurgical intervention, even for biopsy, and the ISCM diagnosis was made by MRI confirmed by PET-18-FDG, which can be used to evaluate this clinical situation when MRI is unavailable [11].…”

“…This occurred in 22.5-39% of ISCM cases [3,6]. However, the diagnosis tends to become more frequent and easier with the development of newer and better imaging methods, mainly spinal cord magnetic resonance imaging (MRI) [1][2][3][5][6][7][8][9][10][11][12].…”

“…Yet, ISCM still has a very poor prognosis because at diagnosis patients usually have very advanced disease with widespread metastasis [5,6,8,11,13], with median survival rates of 4 months since the first symptoms [12].…”