Intradural Extramedullary Spinal Metastases Research Articles

Intradural Extramedullary Spinal Metastases from Non-neurogenic Primary Tumors: A Systematic Review.

Intradural extramedullary spinal metastases (IESMs) may severely affect quality-of-life of oncological patients. Several treatments are available but their impact on prognosis is unclear. We systematically reviewed the literature on IESMs of non-neurogenic origin. PubMed, Ovid EMBASE, Scopus, and Web-of-Science were screened to include articles reporting patients with IESMs from non-neurogenic primary tumors. Clinico-radiological presentation, treatments, and outcomes were analyzed. We included 51 articles encompassing 130 patients of a median age of 62 years (range=32-91 years). The most common primary neoplasms were pulmonary (26.2%), renal (20%), and breast (13.8%) carcinomas. Median time interval from primary tumor to IESMs was 18 months (range=0-240 months). The most common symptoms were sensory (58.3%) and motor (54.2%) deficits. Acute cauda equina syndrome was reported in 29 patients (37.7%). Lesions were diagnosed at magnetic resonance imaging (93.3%), myelography (25%), or computed tomography (16.7%). All patients underwent decompressive laminectomy with tumor resection, partial (54.6%) more frequently than complete (43.1%). Adjuvant radiation (67.5%) and/or systemic (13.3%) therapies were administered. After treatment, most patients had symptom improvement (70.8%) and optimal radiological response (64.2%). Four patients experienced IESMs recurrences (3.1%) with median local tumor control of 14.5 months (range=0.1-36 months). Deaths occurred in 50% of patients, with median overall survival of 6.7 months (range=0.1-108 months). Patients with IESMs have significant tumor burden with poor prognoses. Resection and locoregional radiation may offer favorable clinico-radiological responses but are limited in achieving optimal local control and survival.

Surgical treatment of solitary intradural extramedullary spinal cord metastases from solid cancers of non-neurogenic origin. A multicenter study.

Intradural extramedullary spinal metastases (IESM) represent an extremely rare manifestation of systemic cancer. We evaluated the surgical indications, complications and outcome in a series of 43 patients with solitary intradural extramedullary metastases originating from solid cancer of non-neurogenic origin. Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and post-operative neurological status, extent of the tumor resection were also analyzed. The majority of IEMS occurred in the thoracic area, with the most common presenting symptoms ranging from motor (76.7%) to sensory (72%) deficits. Gross total resection was achieved in 55.8% of cases, while In 44.2% of patients a subtotal resection was performed due to strong adherence between the tumor and neural tissue. After surgery, 72.1% of patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits, while neurologic functional status was severely affected postoperatively in 3 patients. Although there was no statistical significance between the different parameters and overall survival, KPS and the presence of other metastases were the strongest prognostic factors for overall survival and postoperative neurologic outcome.

Isolated cauda equina metastasis from renal cell carcinoma – A rare cause of intradural-extramedullary compression

Intradural extramedullary spinal metastasis is rare, representing 6% of all spinal metastasis. Indeed, intradural metastasis from a Renal Cell Carcinoma to the cauda equina is extremely rare with only 11 case reports present in the past. We present a patient with Cauda equina syndrome with an intradural extramedullary lesion causing compression of the nerve roots. He was subjected to a surgical decompression of the cauda equina with excision of the mass. The pathological examination displayed metastatic clear cell RCC with infiltration of the cauda equina. Thus, metastatic tumors constitute an important differential diagnosis for all lesions of the spine irrespective of level or location. Keywords: Metastatic, Renal cell carcinoma, Intradural, Extramedullary, Cauda equina.

474P Clinical features of intradural extramedullary spinal cord metastases in primary lung cancer

Background Intradural extramedullary spinal cord metastases in lung cancer is rare, and it leads to severe neurological damage. The purpose of this study was to identify the clinical features of intradural extramedullary spinal cord metastases in primary lung cancer patients. Methods 8 cases of lung cancer with intradural extramedullary metastases, who were hospitalized in Peking Union Medical College Hospital (PUMCH) during May, 2013 to May, 2016, wereenrolled in the retrospective study. Medical charts of the 8 patients were reviewed systematically. Results Intradural extramedullary spinal cord metastases was diagnosed in 7 cases with non-small cell lung cancer (NSCLC) and 1 case with small cell lung cancer (SCLC). Cauda equina syndrome was the most common clinical manifestation. Malignant cells in cerebrospinal fluid were positive in all the 5 cases (100%) who underwent lumbar puncture. Contrast-enhanced magnetic resonance imaging (MRI) of spine manifested as diffuse abnormal enhancement of pial lining of spinal cord in 3 cases, intradural extramedullary nodules in 4 cases, and both of themin 1 case. Neurological symptoms were improved or stable in 4 cases who underwent targeted therapy and/or radiotherapy. The median overall survival was 5.8 months (95%CI, 1.9-9.6m). Table: Clinical characteristics and treatment outcomes of patients with intradural extramedullary spinal metastasis Conclusions Intradural extramedullary spinal cord metastases canbe diagnosed with caution according to its neurological symptoms and contrast-enhanced MRI presentation. Targeted therapy and/or radiotherapy may be effectivefor symptoms control. Legal entity responsible for the study Peking Union Medical College Hospital Funding N/A Disclosure All authors have declared no conflicts of interest.

Intradural Extramedullary Spinal Metastases of Non-neurogenic Origin

Leptomeningeal metastases from carcinoma are still poorly understood. To better define the management of unique intradural extramedullary spinal metastases (IESM) from solid cancers of non-neurogenic origin, in particular regarding leptomeningeal metastasis (LM). We conducted a retrospective, multicenter, case-control study including 11 patients with IESM matched with 11 patients with LM. Primary endpoint was overall survival; secondary endpoints were diagnostic criteria and prognostic factors. Descriptive analysis showed a clinically significant difference between IESM and LM patients regarding preexisting neurological deficit (45.5% vs 90.1%, P = .06) and malignant cells in cerebrospinal fluid (0% vs 54.5%, P = .03). The median overall survival was significantly higher for IESM patients (732 days) than for patients with LM (53 days; P < .0002). Multivariate analysis showed that preexisting neurological deficit was a negative prognostic factor for overall survival (hazard ratio: 10.2; 95% confidence interval: 1.88-102; P = .04), in contrast to functional improvement with treatment (hazard ratio: 0.01; 95% confidence interval: 0.00-0.52; P = .04). We propose the following diagnostic criteria for IESM: (1) a solid lesion located within the intradural extramedullary space, (2) the absence of other leptomeningeal lesion seen on full-spine injected magnetic resonance imaging, (3) the absence of malignant cells in cerebrospinal fluid, and (4) a histological confirmation of the metastatic nature of the lesion. The significant difference in survival between IESM and LM suggests that they are 2 distinct evolutions of the metastatic disease. Distinguishing IESM also has therapeutic consequences because patients can benefit from a focal surgical treatment with functional improvement and extended survival.

Spinal drop metastasis from grade I skull base chondrosarcoma

Chondrosarcoma of the skull base is a rare tumour with a good prognosis following surgical resection. We describe a patient with low-grade chondrosarcoma of the skull base with intradural extramedullary spinal metastases. A 31-year-old female with grade 1 chondrosarcoma involving the cavernous sinus, sphenoid wing and clivus presented at age 19. The tumour was subtotally excised at initial surgery and over the following 4 years, 3 subsequent resections were undertaken for tumour progression followed by proton beam radiotherapy to the residual tumour. The patient re-presented with cervical radiculopathy 7 years later. MRI showed multiple, intradural extramedullary spinal drop metastases. Following surgical excision of the symptomatic lesion, histological diagnosis was confirmed as a mixed hyaline/myxoid grade 1 chondrosarcoma. Patients with skull base chondrosarcoma with intradural extension should have whole spine imaging as part of long-term monitoring to exclude drop metastases, particularly after intradural surgery.

Treatment of an intracranial germinoma spinal metastasis

A 20-year-old male with a solitary intradural extramedullary spinal metastasis from a pineal germinoma presented with progressive spinal cord compression. This was initially treated with radiotherapy and the patient showed rapid clinical improvement with complete resolution of his neurological symptoms and signs. Subsequent systemic chemotherapy resulted in complete radiological resolution of the lesion. This case is presented to demonstrate radiotherapy and chemotherapy as a treatment option for germinoma ‘drop’ metastasis causing spinal cord compression, along with a review of the literature.

A Case of Intradural Extramedullary Cord Tumor Metastasis from Adenocarcinoma of the Lung

Intradural extramedullary spinal metastasis from systemic tumor is extremely rare but epidural extramedullary cord tumor metastasis from the lung is relatively common. A 57 year-old male patient was admitted to department of internal medicine and neurosurgery in Chonbuk National University Hospital because of coughing, low back pain radiate to the right great toe, and numbness of the right calf area. Spinal MRI scan revealed round oval shaped mass lesion on just below the level of the conus medullaris. Authors present the clinical, histologic, radiologic features of spinal intradural metastatic tumor and operative total removal followed by chemothrapy with an extensive review of literatures.

Intradural Spinal Metastases in Pediatric Patients with Primary Intracranial Neoplasms

Recently, the application of intravenous gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) has been shown to improve the detection of intradural extramedullary spinal disease in adults. The ability of Gd-DTPA enhanced magnetic resonance (MR) to detect intradural extramedullary spinal metastases was studied in pediatric brain tumor patients. Spinal MR images before and after intravenous injection of Gd-DTPA were analyzed retrospectively in eight pediatric patients with known intracranial neoplasms and clinically suspected subarachnoid tumor seedings. Contrast enhanced spinal MR was compared with CT myelography in four of these patients. In our pediatric population Gd-DTPA enhanced images revealed tumor seeding not appreciable on noncontrast images. Although CT myelography has been the accepted standard investigation in the evaluation of suspected spinal metastases in children, we found that contrast enhanced MR is equal or superior in sensitivity to CT myelography. Spinal MR also provided information not obtainable via CT myelography. In the future, Gd-DTPA enhanced spinal MR should be considered in the initial evaluation of suspected subarachnoid spinal metastases in pediatric patients with known primary brain tumors.

Intradural extramedullary spinal metastasis. A report of 10 cases.

The management of 10 patients with symptomatic localized intradural extramedullary spinal metastasis is reviewed. The single most common primary source was carcinoma of the breast (four cases). The initial symptom in nine patients was pain, with five patients reporting a characteristically severe cramping discomfort with radicular distribution. All patients underwent laminectomy decompression. At the time of surgery, six of the patients were weak but ambulatory and four were bedridden. Following surgery, four patients enjoyed some measure of pain relief, seven patients became ambulatory, and three remained bedridden. Two patients achieved a "satisfactory" result, and were walking and continent 6 months after surgery. Secondary brain tumors were demonstrated or implicated in nine patients, supporting the concept that the spinal metastases represented tertiary deposits following dissemination via the cerebrospinal fluid. Symptomatic intradural extramedullary spinal metastasis causes a virulent clinical syndrome with poor prognosis and disappointing outcome after treatment. Given the high incidence of associated cerebral metastatic involvement, total neuraxis radiation and/or chemotherapy should be considered when symptomatic spinal metastasis is discovered to be intradural and extramedullary.