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Bhattacharya K, Mahajan A, Mynalli S. Imaging Recommendations for Diagnosis, Staging, and Management of Central Nervous System Neoplasms in Adults: CNS Metastases. Cancers (Basel) 2024; 16:2667. [PMID: 39123394 PMCID: PMC11311790 DOI: 10.3390/cancers16152667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/07/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
Brain metastases (BMs) are the most common central nervous system (CNS) neoplasms, with an increasing incidence that is due in part to an overall increase in primary cancers, improved neuroimaging modalities leading to increased detection, better systemic therapies, and longer patient survival. OBJECTIVE To identify cancer patients at a higher risk of developing CNS metastases and to evaluate associated prognostic factors. METHODS Review of imaging referral guidelines, response criteria, interval imaging assessment, modality of choice, as well as the association of clinical, serological, and imaging findings as per various cancer societies. RESULTS Quantitative response assessment of target and non-target brain metastases as well as an interval imaging protocol set up based on primary histological diagnosis and therapy status are discussed as per various cancer societies and imaging programs. CONCLUSION Predictive factors in the primary tumor as well as independent variables of brain metastases like size, number, and response to therapy are necessary in management. The location of CNS metastases, symptomatic disease, as well as follow up imaging findings form a skeletal plan to prognosticate the disease, keeping in mind all the available new advanced therapy options of surgery, radiation, and immunotherapy that improve patient outcome significantly.
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Affiliation(s)
- Kajari Bhattacharya
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India; (K.B.); (S.M.)
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Soujanya Mynalli
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India; (K.B.); (S.M.)
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2
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Kritikos M, Vivanco-Suarez J, Teferi N, Lee S, Kato K, Eschbacher KL, Bathla G, Buatti JM, Hitchon PW. Survival and neurological outcomes following management of intramedullary spinal metastasis patients: a case series with comprehensive review of the literature. Neurosurg Rev 2024; 47:75. [PMID: 38319484 DOI: 10.1007/s10143-024-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
Intramedullary spinal cord metastasis (ISCM), though rare, represents a potentially debilitating manifestation of systemic cancer. With emerging advances in cancer care, ISCMs are increasingly being encountered in clinical practice. Herein, we describe one of the larger retrospective single institutional case series on ISCMs, analyze survival and treatment outcomes, and review the literature. All surgically evaluated ISCMs at our institution between 2005 and 2023 were retrospectively reviewed. Demographics, tumor features, treatment, and clinical outcome characteristics were collected. Neurological function was quantified via the Frankel grade and the McCormick score (MCS). The pre- and post-operative Karnofsky performance scores (KPS) were used to assess functional status. Descriptive statistics, univariate analysis, log-rank test, and the Kaplan-Meier survival analysis were performed. A total of 9 patients were included (median age 67 years (range, 26-71); 6 were male). Thoracic and cervical spinal segments were most affected (4 patients each). Six patients (75%) underwent surgical management (1 biopsy and 5 resections), and 3 cases underwent chemoradiation only. Post-operatively, 2 patients had an improvement in their neurological exam with one patient becoming ambulatory after surgery; three patients maintained their neurological exam, and 1 had a decline. There was no statistically significant difference in the pre- and post-operative MCS and median KPS scores in surgically treated patients. Median OS after ISCM diagnosis was 7 months. Absence of brain metastasis, tumor histology (renal and melanoma), cervical/thoracic location, and post-op KPS ≥ 70 showed a trend toward improved overall survival. The incidence of ISCM is increasing, and earlier diagnosis and treatment are considered key for the preservation of neurological function. When patient characteristics are favorable, surgical resection of ISCM can be considered in patients with rapidly progressive neurological deficits. Surgical treatment was not associated with an improvement in overall survival in patients with ISCMs.
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Affiliation(s)
- Michael Kritikos
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sarah Lee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kyle Kato
- College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kathryn L Eschbacher
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Girish Bathla
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - John M Buatti
- Department of Radiation Oncology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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3
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Gazzeri R, Telera S, Galarza M, Sperduti I, Alfieri A. Prognostic scoring system for surgical treatment of intramedullary spinal cord metastases. J Clin Neurosci 2023; 118:90-95. [PMID: 37897816 DOI: 10.1016/j.jocn.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Although rare, intramedullary spinal cord metastases (ISCMs) are on the rise, most likely due to prolonged survival and improved outcomes as a result of the advances in cancer treatment for cancer patients. While the management of these lesions remains controversial, surgery for ISCM has recently been advocated for selected patients. We performed a retrospective analysis on 30 patients who were surgically treated for intramedullary spinal cord metastases in order to determine a preoperative prognostic scoring system to guide patient selection for surgical interventions. The scoring system was designed to decide between surgery or other therapeutic procedures. The five parameters selected and employed in the assessment system were: 1) patient's general condition, 2) age, 3) primary site of the cancer, 4) number of other extramedullary metastases and 5) severity of neurologic symptoms. Prognosis could not be predicted from a single parameter. These five factors were added together to give a prognostic score between 1 and 10. The average survival period of patients with a prognostic score between 1 and 3 points was 3 months; 11 patients with a score of 4 and 5 points had a mean survival of 7.63 months, while patients with a prognostic score between 6 and 10 was 14.8 months. According to our prognostic scoring system for surgical treatment of ISCM, surgery should be performed in those patients who score above 6 points, while radiotherapy/chemotherapy or palliative care is recommended for those who score between 1 and 3 points. A prognostic score of 4 and 5 represents a grey area where surgeons must use their judgment on whether to intervene either medically or surgically. This scoring system could facilitate decision-making in the management of patients with intramedullary spinal cord metastases.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Interventional and Surgical Pain Management Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Stefano Telera
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Isabella Sperduti
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alex Alfieri
- Neurosurgery, Kantonal Hospital Winterthur, Winterthur, Switzerland; Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus -Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany
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4
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Gazzeri R, Telera S, Galarza M, Callovini GM, Isabella S, Alfieri A. Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications-a multicenter study. Neurosurg Rev 2021; 44:3267-3275. [PMID: 33564982 DOI: 10.1007/s10143-021-01491-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
Intramedullary spinal cord metastasis (ISCM) is a rare event in the course of advanced malignancy. Management of these lesions remains controversial. Recently, surgery for ISCM has been advocated for selected patients. We performed a retrospective analysis of the clinical course, complications, and outcome of 30 patients surgically treated for ISCM. Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and postoperative neurological status, and extent of the tumor resection were also analyzed. Predominant tumor location was thoracic, followed by cervical and conus medullaris. Lung cancer constituted the majority of primary malignancies. In 9 cases, one of the indications for spinal surgery was to obtain a histopathological diagnosis. On admission, all patients presented with neurological symptoms suggestive of myelopathy. After surgery, 18 patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits; 6 patients were unchanged, while 6 patients exhibited postoperative deterioration. Median survival time after surgery was 9.9 months. Age > 70 years old, presence of systemic metastases, preoperative neurological non functional status, and lung cancer as primary tumor were all factors associated with a worse survival prognosis. This study did not show a clear survival difference between gross total and subtotal ISCM tumor resection. Patients who underwent gross total resection had a worse functional outcome with respect to patients with only partial resection. Gross total resection with low morbidity must be the surgical target, but when not possible, subtotal resection and adjuvant therapy are a valid therapeutic option.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy. .,Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy.
| | - Stefano Telera
- Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | | | - Sperduti Isabella
- Department of Biostatistics, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Alex Alfieri
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany
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5
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Intramedullary spinal cord metastases: an institutional review of survival and outcomes. J Neurooncol 2019; 142:347-354. [DOI: 10.1007/s11060-019-03105-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/11/2019] [Indexed: 01/12/2023]
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Saeed H, Patel R, Thakkar J, Hamoodi L, Chen L, Villano JL. Multimodality therapy improves survival in intramedullary spinal cord metastasis of lung primary. Hematol Oncol Stem Cell Ther 2017; 10:143-150. [PMID: 28834695 DOI: 10.1016/j.hemonc.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/29/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most metastatic spinal cord lesions are located either in the intradural, extramedullary, or in the epidural compartments. Intramedullary spinal cord metastasis (ISCM) is a rare central nervous system spread of cancer. The aim of this report was to evaluate ISCM in the published literature. METHODS A literature review of PubMed from 1960 to 2016 was undertaken for the publications having demographic, clinical, histological, and outcome data. RESULTS A total of 59 relevant papers were identified, showing 128 cases of intramedullary metastasis from lung cancer. The incidence of lung cancer as the primary malignancy with intramedullary metastasis was 56%. The median time from diagnosis of primary to intramedullary metastasis was 6months. Survival improved with multimodality therapy compared to monotherapy (4monthsvs. 6.3months) (hazard ratio=0.501; 95% confidence interval, 0.293-0.857). CONCLUSION Lung cancer is the predominant cause of intramedullary involvement of the spinal cord. Overall prognosis is poor, although a multimodality approach was associated with improved survival.
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Affiliation(s)
- Hayder Saeed
- Department of Internal Medicine, Division of Hematology/BMT, Lexington, KY 40536, USA.
| | - Reema Patel
- Department of Internal Medicine, Division of Medical Oncology, Lexington, KY 40536, USA
| | - Jigisha Thakkar
- Department of Neurology, University of Kentucky, Lexington, KY 40536, USA
| | - Lames Hamoodi
- Department of Pathology, University of Kentucky, Lexington, KY 40536, USA
| | - Li Chen
- Biostatistics and Bioinformatics Shared Resources, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - John L Villano
- Department of Internal Medicine, Division of Medical Oncology, Lexington, KY 40536, USA
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7
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Payer S, Mende KC, Westphal M, Eicker SO. Intramedullary spinal cord metastases: an increasingly common diagnosis. Neurosurg Focus 2016; 39:E15. [PMID: 26235013 DOI: 10.3171/2015.5.focus15149] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intramedullary spinal cord metastases (ISCM) represent a small proportion of intramedullary tumors. However, with the lifespans of patients with malignant tumors increasing, incidents of ISCM are on the rise. Due to threateningly severe disabilities in patients, accompanied by limited life expectancy, every attempt should be made to treat these tumors the same way as metastases elsewhere in the CNS, with the goal of complete removal of the ISCM and preservation of neurological functions. The object of this study is to retrospectively analyze the experiences of 22 patients who were surgically treated for ISCM over a 22-year period. METHODS Hospital charts of 22 patients, who were surgically treated for ISCM between 1992 and 2014, were reviewed retrospectively. Demographic data, histopathological diagnoses of primary cancer, chronological sequence of the disease, and neurological status using the simplified McCormick functional classification were collected and reanalyzed. RESULTS The most frequent histology was metastasis of lung cancer, followed by brain and breast cancers. The time span from primary cancer diagnosis to the development of symptomatic spinal metastases ranged from 0 to 285 months, with a mean interval of 38 months. The leading presenting sign was dysesthesia (77% of the population), followed by paresis (68%). Only 5 patients (23%) showed urinary retention. Initial performance status represented by the McCormick Scale was on average 2.47. Total or near-total removal was achieved in 87% of cases. Compared with the clinical status 1-2 days after surgery, there was an improvement in the McCormick Scale grade at the last follow-up from 2.47 to 2.12 (p = 0.009). Likewise, an improvement was detected when comparing the preoperative status with the last follow-up (from 2.45 to 2.12; p = 0.029). The mean survival time after surgery was 11.6 months. CONCLUSIONS These results suggest that surgery for intramedullary metastases-with all of the challenges of a rare and potentially risky procedure-can be beneficial to patients with advanced stages of cancer. Surgery can be performed with minimal new morbidity and results in maintaining neurological performance status.
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Affiliation(s)
- Sebastian Payer
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
| | | | - Manfred Westphal
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
| | - Sven O Eicker
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
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8
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Tan LA, Kasliwal MK, Nag S, O'Toole JE. A rare intramedullary spinal cord metastasis from uterine leiomyosarcoma. J Clin Neurosci 2013; 20:1309-12. [PMID: 23591183 DOI: 10.1016/j.jocn.2012.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 09/26/2012] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma is a rare smooth-muscle-derived malignancy with a significant malignant potential. Systemic metastases are a common late complication of leiomyosarcoma typically to lungs, liver, brain and bones. We report a 44-year-old woman with a prior history of uterine leiomyosarcoma who presented to us with a cervicothoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic leiomyosarcoma, which was followed by adjuvant radiation and chemotherapy. To our knowledge there is no prior report of intramedullary spinal cord metastases (ISCM) from a leiomyosarcoma in the English literature. We report the present patient in view of the rarity of ISCM and its clinical significance. Even though ISCM are unusual, they should be suspected in any patient with primary malignancy irrespective of the histology. The overall prognosis remains grim irrespective of the treatment modality chosen and recognition of the same is important in preoperative counseling and overall treatment approach.
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Affiliation(s)
- Lee A Tan
- Department of Neurosurgery, 1725 West Harrison Street, Suite 855, RUSH University Medical Center, Chicago, IL 60612, USA
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9
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Hsu KC, Li TY, Chu HY, Chen LC, Chang ST, Wu YT. Conus medullaris metastasis in breast cancer: report of a case and a review of the literature. Surg Today 2012; 43:910-4. [DOI: 10.1007/s00595-012-0289-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/15/2012] [Indexed: 11/28/2022]
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10
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Lieberson RE, Veeravagu A, Eckermann JM, Doty JR, Jiang B, Andrews R, Chang SD. Intramedullary spinal cord metastasis from prostate carcinoma: a case report. J Med Case Rep 2012; 6:139. [PMID: 22657386 PMCID: PMC3419088 DOI: 10.1186/1752-1947-6-139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/12/2012] [Indexed: 11/29/2022] Open
Abstract
Introduction Although vertebral and epidural metastases are common, intradural metastases and intramedullary spinal cord metastases are rare. The indications for the treatment of intramedullary spinal cord metastases remain controversial. We present the first biopsy-proven case of an intramedullary spinal cord metastasis from adenocarcinoma of the prostate. Case presentation Our patient was a 68-year-old right-handed Caucasian man with a Gleason grade 4 + 3 prostate adenocarcinoma who had previously undergone a prostatectomy, androgen blockade and transurethral debulking. He presented with new-onset saddle anesthesia and fecal incontinence. Magnetic resonance imaging demonstrated a spindle-shaped intramedullary lesion of the conus medullaris. Our patient underwent decompression and an excisional biopsy; the lesion’s pathology was consistent with metastatic adenocarcinoma of the prostate. Postoperatively, our patient received CyberKnife® radiosurgery to the resection cavity at a marginal dose of 27Gy to the 85% isodose line. At three months follow-up, our patient remains neurologically stable with no new deficits or lesions. Conclusions We review the literature and discuss the indications for surgery and radiosurgery for intramedullary spinal cord metastases. We also report the novel use of stereotactic radiosurgery to sterilize the resection cavity following an excisional biopsy of the metastasis.
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Affiliation(s)
- Robert E Lieberson
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA.
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11
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Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A, Erasmus A, Hunn A. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 2012; 79:576-84. [PMID: 22484768 DOI: 10.1016/j.wneu.2012.04.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 10/30/2011] [Accepted: 04/03/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. METHODS We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. RESULTS Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. CONCLUSION ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.
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Affiliation(s)
- Wen-Shan Sung
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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12
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Abdulazim A, Backhaus M, Stienen MN, Citak M, Brokinkel B, Kuhlmann T, Horch C. Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma. J Clin Neurosci 2011; 18:1405-7. [DOI: 10.1016/j.jocn.2011.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 01/21/2011] [Accepted: 01/27/2011] [Indexed: 11/15/2022]
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Hrabalek L. Intramedullary spinal cord metastases: review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154:117-22. [PMID: 20668492 DOI: 10.5507/bp.2010.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Lumir Hrabalek
- Department of Neurosurgery, Palacky University and University Hospital Olomouc.
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14
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Hrabalek L, Kalita O, Studentova H, Jankova J, Ehrmann J, Trojanec R, Hajduch M. INTRAMEDULLARY SPINAL CORD AND CAUDA EQUINA METASTASIS OF BREAST CARCINOMA: CASE REPORT. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154:175-7. [DOI: 10.5507/bp.2010.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Taricco MA, Guirado VMDP, Fontes RBDV, Plese JPP. Surgical treatment of primary intramedullary spinal cord tumors in adult patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:59-63. [PMID: 18392416 DOI: 10.1590/s0004-282x2008000100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 11/13/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary spinal cord intramedullary tumors are rare and present with insidious symptoms. Previous treatment protocols emphasized biopsy and radiation/chemotherapy but more aggressive protocols have emerged. OBJECTIVE To report our experience. METHOD Forty-eight patients were diagnosed with primary intramedullary tumors. The cervical cord was involved in 27% and thoracic in 42% of patients. Complete microsurgical removal was attempted whenever possible without added neurological morbidity. RESULTS Complete resection was obtained in 33 (71%) patients. Neurological function remained stable or improved in 32 patients (66.7%). Ependymoma was the most frequent tumor (66.7%). CONCLUSION Neurological outcome is superior in patients with subtle findings; aggressive microsurgical resection should be pursued with acceptable neurological outcomes.
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Affiliation(s)
- Mario Augusto Taricco
- Department of Neurology and Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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16
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Dam-Hieu P, Seizeur R, Mineo JF, Metges JP, Meriot P, Simon H. Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 2008; 111:10-7. [PMID: 18930587 DOI: 10.1016/j.clineuro.2008.06.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 06/21/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022]
Abstract
OBJECT Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival. PATIENTS AND METHODS We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed. RESULTS Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients. CONCLUSIONS Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.
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Affiliation(s)
- Phong Dam-Hieu
- Department of Neurosurgery, University of Bretagne Occidentale, School of Medicine and University Medical Center, Brest, France.
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17
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Crowley RW, Sherman JH, Le BH, Jane JA. INTRAMEDULLARY SPINAL CORD METASTASIS FROM BLADDER CARCINOMA. Neurosurgery 2008; 63:E611-2; discussion E612. [DOI: 10.1227/01.neu.0000324898.69073.e1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Intramedullary spinal cord metastases are rare complications of systemic cancer. Although the majority of these metastases spread from lung cancer, they have been seen to arise from a variety of other primary sources. The authors report the second known case of an intramedullary spinal cord metastatic lesion arising from primary bladder carcinoma.
CLINICAL PRESENTATION
A 74-year-old man presented with an 8-day history of rapidly progressive Brown-Séquard syndrome, with weakness in his left lower extremity and decreased pain and temperature sensation in his right lower extremity. The patient's history was significant for high-grade urothelial carcinoma that had been treated 6 months earlier with radical cystectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T1–T2.
INTERVENTION
The patient underwent laminectomies, and removal of his intramedullary lesion was attempted. Intraoperative pathology revealed that the lesion was metastatic in nature, and the decision was made to perform a subtotal resection. Pathology later confirmed that the lesion was consistent with a less differentiated form of his bladder primary. Postoperatively, the patient experienced minimal improvement in his symptoms, and he was subsequently treated with fractionated external beam radiotherapy. The patient died 7 weeks after undergoing surgery for his spinal cord lesion.
CONCLUSION
The occurrence of metastatic primary bladder cancer in the intramedullary spinal cord has been reported in the literature only once previously. Despite the lack of similar cases, the acute onset of Brown-Séquard syndrome was highly suggestive of a metastatic lesion. A review of relevant literature is provided.
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Affiliation(s)
- R. Webster Crowley
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jonathan H. Sherman
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian H. Le
- Department of Pathology, Division of Neuropathology, University of Virginia, Charlottesville, Virginia
| | - John A. Jane
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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de Almeida Holanda MM, de Andrade EMF, da Silva JAG. [Intramedullary spinal cord metastasis from thyorid carcioma: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:338-41. [PMID: 16791383 DOI: 10.1590/s0004-282x2006000200033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of intramedullary spinal cord metastasis from thyroid cancer in a 70-year-old woman complaining for three months an intense cervical pain, without motor or sensitive deficits. Six months before the onset of symptoms, the patient underwent total thyroidectomy for a thyroid cancer. Magnetic resonance imaging with gadolinium enhancement showed an intramedullary spinal cord lesion. A partial resection of the medullar tumor was performed and the pathological findings showed an metastatic adenocarcinoma. Post operatively the patient developed a left crural monoplegia.
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Gazzeri R, Galarza M, Faiola A, Gazzeri G. Pure intramedullary spinal cord metastasis secondary to gastric cancer. Neurosurg Rev 2006; 29:173-7. [PMID: 16465555 DOI: 10.1007/s10143-005-0015-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 11/06/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
Pure intramedullary spinal-cord metastases (ISCM) are a rare manifestation of cancer. We report a case of ISCM from gastric cancer. A 68-year-old man, treated with total gastrectomy for a gastric cancer, presented 9 months later with paresis of the left arm, pain and dissociated sensory loss. Magnetic resonance imaging revealed a pure intramedullary lesion at the C3-C5 level. After surgical resection, pathological findings revealed an undifferentiated adenocarcinoma of gastric origin. To our knowledge, this is only the second report of ISCM from gastric cancer in the literature.
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Affiliation(s)
- Roberto Gazzeri
- UOD Neurochirurgia, Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy.
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Schijns OE, Kurt E, Wessels P, Luijckx GJ, Beuls EA. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000; 102:249-254. [PMID: 11154816 DOI: 10.1016/s0303-8467(00)00106-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors report the case of a 70-year-old woman who developed a Brown-Sequard-syndrome within 6 weeks caused by an intramedullary spinal cord metastasis of an occult renal cell carcinoma. Intramedullary metastases are rare and represent only 4-8.5% of central nervous system metastases. An important feature of intramedullary metastases is the rapid progression of neurological deficits which necessitates rapid treatment. There are only eight earlier reports of intramedullary metastasis due to renal cell carcinoma (Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 1996;47:906-12; Belz P. Ein Fall von intramedullaerer Grawitz-Metastase im Lumbalmark. Frankfurt Z Pathol 1912;10:431-44; Gaylor JB, Howie JW. Brown-Sequard-syndrome. A case of unusual aetiology. J Neurol Neurosurg Psychiatry 1938;1:301-5; Kawakami Y, Mair WGP. Haematomyelia due to secondary renal carcinoma. Acta Neuro Pathol 1973;26:85-92; Strang RR. Metastatic tumor of the cervical spinal cord. Med J Aust 1962;1:205-6; Von Pfungen. Uber einige Fälle von Haematomyelie nichttraumatischen Ursprungs. Wien Klin Rdsch 1906;20:44-50; Weitzner S. Coexistent intramedullary metastasis and syringomyelia of cervical spinal cord. Report of a case. Neurology 1960;674-8). To the best of our knowledge this is the first report on a patient in whom symptoms from the metastasis of a renal cell carcinoma preceded the detection of the primary tumor. This report presents the clinical, neuroradiological and histopathological findings of an intramedullary metastasis of a renal cell carcinoma and provides an overview of the literature on intramedullary spinal cord metastases.
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Affiliation(s)
- O E Schijns
- Department of Neurosurgery, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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