Primary spinal cord glioblastoma: A rare cause of paraplegia

Abstract

Background: Primary spinal glioblastomas are extremely rare neoplasms and account for only 0.2% of glioblastoma cases. Due to the rare incidence of spinal cord glioblastoma in the literature, its natural history/ outcome remains undetermined. The present article describes the clinical presentation, radiological/pathological characteristics, and outcome of the primary spinal cord glioblastoma. Case Description: Two young patients initially presented with paresis that rapidly progressed to paraplegia. Nondermatomal sensory deficits were also noted, mainly affecting the lower limbs. Neuroradiological imaging revealed an extensive intramedullary spinal cord lesion, with no evidence of concurrent intracranial space-occupying lesions. Thoracic laminectomy, followed by tumor debulking and/or biopsy, was performed. The histomorphology was suggestive of glioblastoma, the World Health Organization grade 4 (Isocitrate Dehydrogenase-wild type). They were discharged in stable condition and were started on chemoradiotherapy, with clinicoradiological follow-up. One patient passed away after 9 months of initial presentation. The other patient was alive at 6-month follow-up. Conclusion: Primary spinal glioblastoma is a rare and challenging tumor. Patients commonly present with a progressive paresis, resulting in paraplegia, regardless of the surgical resection extent, and received adjuvant chemotherapy. Therefore, primary spinal cord glioblastoma should be considered in patients reporting a rapid lower limb weakness with neuroradiological evidence of extensive, exophytic intramedullary lesion of the spine. A biopsy-proven histopathological diagnosis is of indisputable importance to establish the final diagnosis and plan treatment options.

Atypical imaging features of the primary spinal cord glioblastoma: A case report

“…PSC GB is extremely rare, reported in about 1.5% of all the spinal cord tumors[ 9 ]. Due to its rare occurrence, few studies focus on it.…”

“…Although not implying causation, there is a trend towards improved overall survival with the use of chemotherapy and surgical resection for patients suffering from GB[ 21 ]. Despite the advancement in surgical techniques and postoperative adjuvant therapies, PSC GB still has an overall poor prognosis[ 9 , 21 ]. The overall survival in patients with PSC GB is approximately 10-14 mo[ 9 ].…”

“…Despite the advancement in surgical techniques and postoperative adjuvant therapies, PSC GB still has an overall poor prognosis[ 9 , 21 ]. The overall survival in patients with PSC GB is approximately 10-14 mo[ 9 ]. The disease often leads to severe neurological deficits and poor quality of life, even after treatment.…”

Long-term survival after cordectomy in a case of spinal cord diffuse midline glioma, H3K27-altered: illustrative case

“… 6 , 7 The impact of the extent of resection is controversial, and the preservation of neurological function is emphasized. 3 , 7 , 8 …”

“…Spinal cord grade 4 glioma is proposed to spread via two mechanisms: dissemination through the leptomeningeal pathway 8 and contiguous extension/invasion along the nerve fiber bundles. 16 Theoretically, cordectomy forestalls both mechanisms by blocking the cerebrospinal fluid (CSF) route and severing the nerve fiber pathway to infiltrate.…”