Symptomatic Spinal Metastases from Intracranial High-grade Glioma – Report of Four Cases and Review of the Literature

Abstract

Intraspinal (leptomeningeal or intramedullary) metastases from primary intracranial gliomas have been well documented in several clinical and pathological series; however, symptomatic intraspinal metastases remain rare. We conducted a retrospective search of cases of intraspinal metastases treated at our centre and report four cases of symptomatic intraspinal leptomeningeal and intramedullary metastases from an intracranial glioma. The mean age of the four cases was 43 years (range 28–55 years). The intraspinal metastases were detected after a median time of 18.5 months after onset of the disease and the median survival time of the four patients from detection of spinal metastases was one month. Median overall survival of the four patients was 19 months. One patient was treated with surgery and all received radiotherapy treatment. Radiotherapy provided good initial palliation of pain but improvement in neurological deficits was limited.Overall, prognosis in cases of leptomeningeal and intramedullary metastases from primary intracranial glioma is very poor; however, this diagnosis should be considered in patients with malignant glioma presenting with new back pain and/or associated spinal neurological signs or symptoms. Radiotherapy provided relief of pain and some improvement in neurological function but no survival advantage. Clinical awareness and recognition of this entity will become increasingly important as local control of primary malignant glioma improves and corresponding improvements in outcome and prognosis of this disease are observed.