Dural metastases. A retrospective surgical and autopsy series.

Abstract

Background Metastases to dura constitute one of the least frequent and least studied patterns of neoplastic spread to the craniospinal axis. Older reports cited breast cancer as accounting for the largest number of dural metastases, often as a manifestation of end-stage disease. Since the early 1980s we have noted an increasing number and diversity of cancer types in patients with dural metastases in our surgical and autopsy neuropathology experience. Some surgical patients have experienced prolonged postoperative survival. Methods Review of autopsy records from 1982 to 1999 and surgical pathology records from 1990 to 2000 at a large university teaching hospital, including consultation files. Results Dural metastases removed at surgery (n = 33) were usually single, cranial, subdural lesions; coexistence with brain parenchymal or skull metastases varied according to tumor type. Unusual tumor types included carcinomas of colon, endometrium, cervix, and stomach. One well-documented patient developed postsurgical implantation metastases, and 2 patients had co-associated acute subdural hematomas. Surgical patients showed widely varying postoperative survival times, but in several of these patients survival times were in excess of 2 years. Dural metastases seen at autopsy (n = 27) could also be solitary and nodular, but more examples were extensive, diffuse, and both subdural and epidural in location. The expected cases of breast cancer (n = 5) occurred, but more examples of prostate cancer (n = 7) or unusual malignant neoplasms (cervical = 3, laryngeal = 1, gallbladder = 1, Ewing sarcoma = 1, intravascular lymphomatosis = 1, ocular melanoma = 1) were identified. Conclusions This combined surgical and autopsy series shows a different distribution of tumor types causing dural metastases than older series. Postoperative outcome may be favorable in select, surgically treated patients.