Cervical spine metastasis from adrenal pheochromocytoma

Kheir, Ehab; Pal, Debashish; Mohanlal, P; Shivane, Aditya G.; Chakrabarty, Aruna; Timothy, Jake

doi:10.1007/s00701-006-0892-4

Cited by 13 publications

(20 citation statements)

References 5 publications

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“…1,22 Most studies of spinal metastases have shown a postoperative improvement in blood pressure, headaches, palpitations, and anxiety; delayed complications have usually been associated with tumor recurrence or distant metastasis. 11,13,15,33 We demonstrated that en bloc resection in one of our patients (Case 5) was associated with postoperative hypertensive cure. 12 The reasons for this are unknown but may be related to a reduction in the tumor burden and subsequent decrement in catecholamine secretion.…”

Section: Discussionmentioning

confidence: 62%

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Kaloostian

Zadnik

Kim

et al. 2014

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Pheochromocytomas of the spine are uncommon and require careful preoperative planning. The authors retrospectively reviewed the charts of 5 patients with metastatic spinal pheochromocytoma who had undergone surgical treatment over the past 10 years at their medical center. They reviewed patient age, history of pheochromocytoma resection, extent and location of metastases, history of alpha blockage, surgical level, surgical procedure, postoperative complications, tumor recurrence, and survival. Metastases involved the cervical (1 patient), thoracic (3 patients), and lumbar (2 patients) levels. Preoperative treatment included primary pheochromocytoma resection, chemotherapy, alpha blockade, embolization, and radiation. Three patients had tumor recurrence, and 2 underwent 2-stage reoperations for tumor extension. Hemodynamic complications were common: 2 patients developed pulseless electrical activity arrest within 4 months after surgery, 1 patient had profound postoperative tachycardia with fever and an elevated creatine kinase level, and 1 patient experienced transient postoperative hypotension and paraplegia. One patient died of complications related to disseminated cerebral and spinal disease. With careful preoperative and surgical management, patients with symptomatic metastatic spinal pheochromocytoma can benefit from aggressive surgical treatment. Postoperative cardiovascular complications are common even months after surgery, and patients should be closely monitored long term.

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Section: Discussionmentioning

confidence: 62%

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Kaloostian

Zadnik

Kim

et al. 2014

SPI

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“…The authors noted no hemodynamic changes during this procedure and detailed the safety of this approach. Kheir et al 8 reported on a patient with myelopathy who required a 2-level cervical corpectomy followed by posterolateral instrumentation and fusion. The authors described successful stabilization of the vertebrae with spinal cord decompression.…”

Section: Discussionmentioning

confidence: 99%

“…3,7,8 No reports of en bloc resection have been described. In addition, no report of postoperative hypotension with associated transient neurological decline has been reported.…”

mentioning

confidence: 99%

En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension

Kaloostian¹,

Zadnik²,

Awad³

et al. 2013

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Resection of metastatic pheochromocytomas may be complicated by transient postoperative neurological deficits due to hypotension. The authors report the first case of en bloc excision of a spinal pheochromocytoma with associated long-term hypertensive management off all medication. Interestingly, this is the first case of transient hypotension following en bloc resection of pheochromocytoma associated with temporary hypotension-associated neurological decline that resolved completely after correction of hypotension postoperatively. A 23-year-old man with a prior adrenalectomy for pheochromocytoma presented with focal thoracic pain. He had a known T-10 vertebral body lesion for which he received chemotherapy and radiation therapy. Imaging demonstrated increased destruction of the T-10 vertebral body, which was concerning for tumor growth. The patient underwent angiographic embolization followed by single-stage posterior en bloc vertebrectomy with placement of a cage and posterior instrumentation and fusion without event. However, approximately 24 hours after surgery, the patient's systolic blood pressure was consistently no higher than 70 mm Hg. During this time, he began suffering from severe bilateral lower-extremity weakness. His systolic blood pressure increased with dopamine, and his strength immediately improved. The patient's oral regimen of adrenergic blockade was stopped, and he recovered without event. Since that time, the patient has been symptom free and requires no antihypertensive medication. The role of en bloc resection for metastatic lesions of the spine is controversial but may be warranted in cases of metastatic pheochromocytoma. En bloc resection avoids intralesional tumor resection and thus may help prevent complications of hypertensive crisis associated with hormonal secretion and extensive blood loss, which are not uncommon with pheochromocytoma resection surgeries. Additionally, the role of en bloc spondylectomy in this setting may allow for metabolic treatment as patients with actively secreting tumors may no longer require antiadrenergic medications.

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“…Isolated metastatic spread of pheochromocytoma to vertebral bodies is extremely rare 29 . There are only a few reports in the literature of vertebral metastases [7][8][9][10][11][12][13][14][15][16][17][18] . Our patient's presentation of an extradural thoracic pheochromocytoma is an uncommon occurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The most common locations for metastasis include bone, liver, lymph node, lung 2,4,6 and spleen 7 . Although bones are the most common site for metastases, vertebral involvement is rare with only a few cases reported [7][8][9][10][11][12][13][14][15][16][17][18] . The prognosis for metastatic pheochromocytoma is poor with few cases of long term survival 2,7,19,20 .…”

Section: Introductionmentioning

confidence: 99%

Metastatic adrenal pheochromocytoma to the thoracic spine

2010

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To report on a case of pheochromocytoma metastases to the spine occurring more than 20 years after initial diagnosis. A 34-year-old female with a history of metastatic pheochromocytoma diagnosed at age 12 presented with weakness, heart palpitations, and circumferential back pain of five months duration. The patient had undergone multiple laparatomies for abdominal and hepatic metastases. Work-up revealed a destructive lesion at T9. After two weeks of preoperative phenoxybenzamine to control her hypertension, she underwent decompression, posterior fixation and fusion. Surgical intervention was followed by radiation therapy, zoledronic acid, and only one cycle of chemotherapy due to intolerance of side effects. The patient survived 25 years after original diagnosis, which far exceeds the average survival of less than 15 years. The patient died 26 months postoperatively due to progression of disease. Pheochromocytoma with spine metastases occurring more than 20 years after diagnosis is very uncommon, and should be considered in the differential diagnosis of a patient with a history of pheochromocytoma.

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Cervical spine metastasis from adrenal pheochromocytoma

Cited by 13 publications

References 5 publications

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension

Metastatic adrenal pheochromocytoma to the thoracic spine

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