The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment

Abstract

The authors retrospectively reviewed the surgical outcomes in 10 cases of symptomatic intradural extramedullary spinal metastases of nonneurogenic origin because the collective experience in treating this rare manifestation of systemic cancer is limited. Pain and weakness were the presenting complaints in 70% of the patients and sensory changes were found in all cases. Cytological tests on one specimen of cerebrospinal fluid (CSF) from each of seven patients showed malignant cells in two cases. Gadolinium contrast-enhanced biplanar magnetic resonance (MR) imaging was effective in localizing the lesion and showed evidence of leptomeningeal carcinomatosis in two cases; myelography showed leptomeningeal carcinomatosis in one case and erroneously identified the lesion as intramedullary in the other. Eight of 10 cases had antecedent intracranial metastatic foci with the interval from presentation of the intracranial lesion to appearance of the spinal disease ranging from 3 to 51 months. The majority of the spinal lesions occurred in the thoracolumbar area. The most frequent histological type was adenocarcinoma and the most frequent source was the lung. In all cases laminectomies, intradural exploration, and biopsy or subtotal excision aided by microscopy and ultrasonography were performed. Results of surgical decompression were poor with only 30% of the patients showing improvement, at a 20% risk of perioperative mortality and a 60% risk of morbidity. Plans for surgical intervention in patients with intradural extramedullary metastases from a distant noneurogenic source should be weighed against the high association with intracranial lesions, overall poor prognosis, and modest symptomatic results of decompression. Comprehensive evaluation including multiple specimens of CSF for cytology and contrast-enhanced MR imaging should be undertaken to exclude patients with diffuse leptomeningeal involvement, who should be treated by means other than surgery.

Disseminated Leptomeningeal Carcinomatosis; Presenting With Cauda Equina-conus Syndrome

“…[1][2][3][4][5] Disk hernisi, tümör, penetran travma, cerrahi manipulasyon, ankilozan spondilit, serbest epidural ya dokusu bas s , lomber spondilozis, dar kanal ve nadiren bu bölgeyi tutan metastazlar KES nedenleri aras ndad r. [6][7][8] Literatürde artan s kl kla KES' e neden olan ve kauda equinay tutan metastaz olgular bildirilmektedir. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Biz, akci er kanseri tan s ile izlenen ve kauda equina-konus sendromu ile gelen, beyin metastaz olmadan, lomber düzeyde dissemine tarzda intradural ekstrameduller, leptomeningeal metastazlar saptanan olguyu sunmak istedik.…”

“…[1][2][3][4][5]9] Bu bölgede en s k, primer komponentlerinden kaynaklanan tümörler görülmekle beraber, metastazlar gittikçe artan s kl kta bildirilmektedir. [1][2][3][4][5][9][10][11][12][13][14][15][16][17] Beyin metastaz olmadan spinal leptomeningeal karsinomatozise oldukça nadir rastlanmakla beraber, nadir bir tabloyla, kauda equina-konus sendromu olarak kar m za ç kan bu olguyu sunmak istedik.…”

“…%2-4 olguda primer odak saptanamamaktad r. [2,6] Spinal metastazlar da son y llarda artan s kl kta KES nedenleri aras nda bildirilmektedir. [1][2][3][4][5][9][10][11][12][13][14][15][16][17] Kotil ve ark [3] primer maligniteye ait bulgular saptanmadan, L4/5 düzeyinde kitle ve KES sendromu ile ortaya ç kan …”

“…[1][2][3][4][5][6]9,11,13] Tümör hücreleri BOS a geçti inde multifokal tutulum veya diffuz infiltrasyona neden olabilir. Akci er kanserleri, arteriyel disseminasyon ile yay lmaktad r. [1][2][3][4][5][6]9] Bununla beraber, lomber düzeyde izlenen LK, genellikle, intrakranial sekonder lezyonlardan damla metastaz olarak, kauda equinada sinir kökleri boyunca yay lmaktad r. [6,9] Olgumuzda beyin metastaz saptanmam t r. Chow and McCurcheon [11] serilerinde, LK izlenen olgular n %80'inde intrakranial metastaz saptam t r. Bu olgu grubunda en s k primer malignite akci er adenokarsinomu olarak bildirilmi tir. Pavlidis [13] ise serisinde meme kanserini en s k primer malignite olarak bildirmi tir.…”

Intradural-Extramedullary Metastatic Tumor from Lung Cancer-A Case Report and Review

“…Including our case, the total number of reported cases is now 102. Many authors have described an intradural-extramedullary metastasis as a rare metastatic condition, however, we do not consider it to be rare given the number of reported cases.Two types of treatment have been reported for an intraduralextramedullary tumor, the recommended operative and nonoperative methods [4,18,31,38,45,63]. In two case studies, Perrin et al…”