Microsurgical Resection of Lung Carcinoma Spinal Cord Metastasis: 2-Dimensional Operative Video

Abstract

This video demonstrates microsurgical resection of intramedullary spinal cord metastasis of lung adenocarcinoma. Lung cancer is the predominant cause of rare metastatic intramedullary involvement of the spinal cord.1-4 Because of severe disabilities, these tumors should be considered for treatment with the goal of complete removal to preserve neurological functioning.5-9 Surgical resection improves symptoms, preserves ambulatory status, and increases survival time twice that of nonsurgical treatments.3,8,10 Surgery can be effective in arresting neurological decline.11,12 To our knowledge, this is the first video report of an intramedullary spinal cord metastasis resection. A 69-yr-old male with history of lung cancer presented with acute onset left arm abduction, forearm flexion, and hand weakness (3/5) and gait disturbance. Cervical spine MRI revealed C4/C5 nonhomogenously enhancing intramedullary tumor measuring 22 × 10 × 7 mm. Sagittal T2-weighted image demonstrated extensive cord edema. The C4 and C5 laminectomies were performed. Microsurgical techniques were employed.13-15 Metastasis involved the left lateral aspect of the cord with invasion of 2 left dorsal sensory nerve roots, which were resected. Further transection of the dentate ligament relaxed the spinal cord, enabling safer tumor resection. Pial dissection using bipolar forceps, microscissors, and microdissector enabled tumor delivery. Following resection, dural closure was reinforced with previously harvested fat tissue graft to prevent CSF leak.16 Postoperative MRI revealed complete macroscopic resection with improvement of spinal cord swelling. Patient improved his gate and his left arm motor strength was stable. Subsequently, patient received focal adjuvant radiotherapy. Written consent was obtained directly from the patient.

Animal models of brain and spinal cord metastases of NSCLC established using a brain stereotactic instrument

“…Brain metastasis is the leading cause of death in lung cancer patients and one of the common causes of treatment failure [ 25 , 26 ], and the patients are often accompanied by neurological dysfunction caused by the occupancy of brain metastases and have inferior quality of life [ 27 , 28 ]. Spinal cord metastasis—also malignant metastasis—is characterized by rapid clinical progression and a poor prognosis [ [29] , [30] , [31] , [32] ]. Primary tumors that can develop spinal cord metastasis include lung cancer, breast cancer [ 33 ], and melanoma [ 34 ], etc., with lung cancer being the most prone to spinal cord metastasis [ 35 , 36 ].…”