Abstract
IntroductionAlthough 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 presentationOur 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.ConclusionsWe 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.
Highlights
Vertebral and epidural metastases are common, intradural metastases and intramedullary spinal cord metastases are rare
We report the novel use of stereotactic radiosurgery to sterilize the resection cavity following an excisional biopsy of the metastasis
We are aware of no prior reports of biopsy-proven intramedullary spinal cord metastases (ISCMs) due to prostate cancer
Summary
Metastases to the intramedullary spinal cord are rare and typically occur late in the course of the disease. Surgery is appropriate for those patients who can tolerate the operation and who are in danger of permanent loss of function or who have intractable pain. Conventional spinal radiation has been provided to decrease the risk of local recurrence. There is risk to spinal radiation and not all tumors are radiosensitive. We propose that a local cavitary boost with SRS may be as effective as conventional radiation for some tumors while offering greater convenience and perhaps less risk. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they do not have any competing interests
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