Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin

Löhr, Mario; Tzouras, Georgios; Köcher, Martin; Stenzel, Werner; Reithmeier, Thomas; Klug, N.; Hampl, Jürgen A.

doi:10.1007/s00701-009-0214-8

Cited by 12 publications

(6 citation statements)

References 31 publications

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“…Furthermore, it is unclear preoperatively which types of metastases will be amenable to complete resection. In some case reports, tumor resection was reported as en block [14,19,21,27,28], whereas others convey adherence of the tumor to neural elements precluding subtotal resection [7,10,18,20,22,23,26]. Our case was consistent with the latter-intimately associated with the intradural rootlets of the cauda equina.…”

Section: Surgical Considerationssupporting

confidence: 80%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.

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Section: Surgical Considerationssupporting

confidence: 80%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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“…Dagan et al (53) reported one case of cervical LM detected at follow-up imaging in one patient with no new spinerelated symptoms. Spine LMs were most frequently diagnosed at MRI T1-contrast scans with or without CSF cytologic analysis (66.7% and 25% cases, respectively), and confirmatory histopathological diagnosis was obtained only in 6 patients (7.3%) (23,26,30,56,62). At neuroimaging, most spine LMs were located in the lumbar-sacral (18.1%), thoracic-lumbar-sacral (18.1%), or lumbar (12.5%) regions, showing nodular (63.6%) or diffuse (36.4%) leptomeningeal enhancement.…”

Section: Resultsmentioning

confidence: 99%

Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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Background/Aim: Leptomeningeal metastases (LMs) of the spine have complex management. We reviewed the literature on spine LMs. Materials and Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of spine LMs. Results: We included 46 studies comprising 72 patients. The most frequent primary tumors were lung (19.4%) and breast cancers (19.4%). Median time from primary tumors was 12 months (range=0-252 months). Cauda equina syndrome occurred in 34 patients (48.6%). Nodular spine LMs (63.6%) were more frequent. Concurrent intracranial LMs were present in 27 cases (50.9%). Cerebrospinal fluid cytology was positive in 31 cases (63.6%). Cases were managed using palliative steroids (73.6%) with locoregional radiotherapy (55.6%) chemotherapy (47.2%), or decompressive laminectomy (8.3%). Post-treatment symptom improvement (32%) and favorable radiological response (28.3%) were not different based on treatment (p=0.966; p=0.727). Median overallsurvival was 3 months (range=0.3-60 months), not significantly different between radiotherapy and chemotherapy (p=0.217). Conclusion: Spine LMs have poor prognoses. Radiotherapy, chemotherapy, and surgery are only palliative, as described for intracranial LMs.Leptomeningeal metastases (LMs) are late-stage complications of systemic malignancies, occurring approximately in 5-10% of patients with solid and hematologic neoplasms (1, 2). Frequently manifesting with new neurological deficits, LMs may be detected at T1-contrast MRI follow-ups as nodular or diffuse meningeal enhancement, and may be confirmed with high-volume cerebrospinal fluid (CSF) taps for cytology (3,4). Several systemic therapeutic options are available, but the treatment goal remains palliation, as mean survival ranges 3-6 months (3,5,6).LMs involving the spine represent unique entities that may severely impact patients' functional status (7, 8). While diffuse spinal LMs may remain clinically silent and go undetected, nodular spinal LMs frequently compress spinal nerve roots causing radicular pain or neurological impairments (2, 9). Nodular spinal LMs may also lead to acute or progressive cauda equina syndrome, which require urgent diagnosis and management (10,11). While surgical decompression may provide prompt symptomatic relief, patients may not be good candidates due to their significant tumor burden (2, 3). In these cases, locoregional radiation, chemotherapy, and other systemic treatments may be pursued to achieve similar clinical outcomes (12, 13).Although spinal LMs pose significant challenges in the oncological care of patients with systemic metastases, only 619 This article is freely accessible online.

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“…Treatment for these patients included intrathecal chemotherapy, 3 , 9 , 10 systemic chemotherapy, 3 , 10 , 13 , 15 spinal irradiation, 3 , 11 , 14 , 15 laminectomy, 13 , 16 – 19 high doses of dexamethasone, 11 , 14 and tyrosine kinase inhibitors. 12 The 35 patients undergoing a single medical intervention, excluding tyrosine kinase inhibitor treatment, survived an average of 3.19 months, 9 , 10 , 14 , 16 , 18 whereas the 5 patients who underwent tyrosine kinase inhibitor treatment or two or more interventions survived an average of 10.8 months. 3 , 12 , 13 , 15 , 19 Chemotherapy is the basic therapy for these patients.…”

Section: Discussionmentioning

confidence: 99%

Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: a case report and review of literature

Liu¹,

Wang²,

Qian³

et al. 2018

OTT

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Cauda equine syndrome (CES) is a neurological condition caused by compression of the cauda equine. Here, we demonstrate a case of CES as the primary symptom of leptomeningeal metastases from non-small cell lung carcinoma without brain metastases. A 59-year-old male suffered progressive lower extremity motor dysfunction, urinary dysfunction, and lower extremity sensory dysfunction. He was clinically diagnosed with CES. Nuclear magnetic resonance imaging demonstrated several vague nodules in the area of conus medullaris and cauda equine, without lumbar or thoracic herniated discs. The serum carcinoembryonic antigen concentration was 191.20 ng/mL. The conclusion following positron emission tomography–computed tomography was a right upper lung malignant tumor with mediastinal lymph node metastasis and cauda equina metastasis. Pathologic diagnosis was of primary adenocarcinoma of the lung by bronchoscopic biopsy. EML4–ALK fusion and EGFR mutations were absent, and thus the patient received chemotherapy. However, symptoms of intracranial hypertension arose 1 month later, and the patient died 3 months postadmission. Emerging CES may be a sign of metastasis of a malignant tumor, presenting an extremely challenging condition, especially for patients with lung cancer. Positron emission tomography–computed tomography is a fairly effective technique to make the diagnosis.

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Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin

Abstract: Surgical treatment of compressive intradural metastases of the cauda equina seems to be feasible with low operative risk and with the potential benefit of an immediate relief of pain and improvement in motor function and thus an increase in quality of life.

Cited by 12 publications

References 31 publications

Intradural extramedullary metastasis: a review of literature and case report

Intradural extramedullary metastasis: a review of literature and case report

Leptomeningeal Metastases of the Spine: A Systematic Review

Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: a case report and review of literature

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