Cauda equina syndrome caused by lumbar leptomeningeal metastases from lung adenocarcinoma mimicking a schwannoma

Abstract

Background: Cauda equina syndromes (CESs) due to leptomeningeal metastases from primitive lung tumors are rare. Despite recent advancements in neuro-oncology and molecular biology, the prognosis for these patients remains poor. Here, we present a case in which a patient developed lumbar leptomeningeal metastases from lung carcinoma that contributed to a CES and reviewed the appropriate literature. Case Description: A 55-year-old female presented with the left lower extremity sciatica/weakness. Two years ago, a then 53-year-old female had received Gamma Knife stereotactic radiosurgery (SRS) for a cerebellopontine angle schwannoma. Recently, she underwent resection of lung carcinoma and SRS for a right hemispheric cerebellar metastasis. Now at age 55, she presented with the left lower extremity sciatica/weakness. When her new lumbar MR was interpreted as showing a L5 schwannoma, a L4-L5 laminectomy was performed at surgery, the authors encountered multifocal leptomeningeal metastases densely infiltrating the cauda equina. Although only subtotal resection/decompression of tumor was feasible, she did well for the ensuing year. The histological diagnosis confirmed the lesion to be a poorly differentiated lung adenocarcinoma. Conclusion: Patients with a history of prior metastatic lung cancer may present with spinal leptomeningeal metastases resulting in a CES.

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

“…Such an experience was based on the use of Gamma Knife radiosurgery whose excellent conformity index, Paddick index, dose fall-off and gradient index, especially in challenging situations (i.e. irradiation of adjacent or critically located targets [48] , [49] , [50] ), characterize a different dose distribution in healthy brain tissue with respect to the LINAC-based stereotactic technique, thus being able to produce different neurocognitive outcomes [51] . An evaluation of these is therefore useful and should be carried our for both techniques.…”

Leptomeningeal Metastases of the Spine: A Systematic Review

“…However, as these symptoms may also occur in other benign or malignant conditions, including intervertebral disc herniation or vertebral fracture, patients' history of oncological disease and systemic metastases should be investigated to plan appropriate metastatic diagnostic protocols (71,72). The occurrence of cauda equina syndrome has also been largely reported across our included studies (51,(54)(55)(56). This likely owes to the fact that CSF circulation is slower in the cauda equina and the basilar cisterns, which represent the two regions mostly affected by leptomeningeal seeding (66, 67).…”

“…Dagan et al (53) reported one case of cervical LM detected at follow-up imaging in one patient with no new spinerelated symptoms. Spine LMs were most frequently diagnosed at MRI T1-contrast scans with or without CSF cytologic analysis (66.7% and 25% cases, respectively), and confirmatory histopathological diagnosis was obtained only in 6 patients (7.3%) (23,26,30,56,62). At neuroimaging, most spine LMs were located in the lumbar-sacral (18.1%), thoracic-lumbar-sacral (18.1%), or lumbar (12.5%) regions, showing nodular (63.6%) or diffuse (36.4%) leptomeningeal enhancement.…”

“…Yet, the higher toxicity of intrathecal agents should be considered, especially in patients with LM-induced CSF obstruction (65, 75). As reported for patients with primary gliomas, surgery is limited for spine LMs, mostly intended to relieve compression-related symptoms with decompressive laminectomy and tumor debulking, but carries severe risks of complications and shows no impact on patients' prognoses (8,23,26,56). Finally, newer molecular therapies and immunotherapies have been showing promising results for the treatment of intracranial LMs by simultaneously modulating microenvironments of primary tumors and metastatic lesions, but their role in spine LMs has been poorly studied (69,77).…”

Focused Ultrasound in Neuroscience. State of the Art and Future Perspectives

“…Regarding clinical applications of focused ultrasound, it has been recently demonstrated that tcMRgFUS postero-central lateral thalamotomy is an effective treatment of drug-resistant chronic neuropathic pain and trigeminal neuralgia [ 40 ]. In contrast, local MRgFUS ablation effectively treats pain related to lumbar bone metastases [ 43 , 44 ].…”