Diagnosis and management of spinal metastasis of primary brain tumours

Chen-Zhao, X.; Aznar-Garcia, L.

doi:10.21037/acr.2018.03.02

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…Although aggressive in nature, glioblastomas only rarely metastasize to the leptomeninges, 45,46 which occurs more frequently in younger patients. 45 Therefore, imaging of the spinal cord is rarely indicated in patients with supratentorial glioblastoma unless there is a high clinical suspicion for leptomeningeal or drop metastases.…”

Section: Spinal Metastases From Central Nervous System Tumorsmentioning

confidence: 99%

Myelopathies from Neoplasms

Lim-Fat

Dietrich

2021

Semin Neurol

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Benign and malignant tumors can be an important cause of myelopathy. Patients may present with a wide range of neurologic symptoms including back and neck pain, weakness, sensory abnormalities, and bowel and bladder dysfunction. Management can be challenging depending on the location and underlying biology of the tumor. Neuroimaging of the spine is an important component of diagnostic evaluation and patient management both during initial evaluation and when monitoring after treatment. This article provides a systematic and practical review of neoplasms that can cause myelopathy. Unique imaging and biological features of distinct tumors are discussed, and their management strategies are reviewed.

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Section: Spinal Metastases From Central Nervous System Tumorsmentioning

confidence: 99%

Myelopathies from Neoplasms

Lim-Fat

Dietrich

2021

Semin Neurol

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“…GBM cells migrate from the initial tumor site along brain vessels to subpial, subarachnoid, and subependymal spaces (Fig. 2A) [5, 10, 35, 36]. The leptomeningeal seeding from cortical areas is preceded by subpial spread as an intermediary step [5, 10, 17, 35].…”

Section: Pathogenesismentioning

confidence: 99%

“…Clinical presentation of LMS is heterogeneous, from asymptomatic to severely symptomatic disease [1, 6, 11, 12, 15, 29, 31, 67]. Usually the onset and the worsening of symptoms are progressive; acute presentation is exceptional [5, 12, 27, 36, 68–70].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Progressive paraplegia [9, 27, 36, 69, 73, 83, 84], sphincter incontinence [1, 11, 36, 55, 80, 84], and spinal ataxia [20, 29, 80] were described when the spinal cord or cauda equina are involved [9, 29, 30, 33, 69, 73, 85, 86]. Isolated symptoms such as paresthesia, ataxia, back pain, and leg or shoulder pain are rare [27, 29, 87, 88].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Spinal LMS has been reported to be more frequently in lower thoracic, upper lumbar (most often posterior) [36, 101], lumbosacral regions, cauda equina, and dural sac [36]. Thirty‐one percent of lesions are described on the cervical level, 52% on the thoracic level, and 41% at the lumbar level (Fig.…”

Section: Diagnostic Approachmentioning

confidence: 99%

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Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

et al. 2020

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Background Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor. Leptomeningeal spread (LMS) is a severe complication of GBM, raising diagnostic and therapeutic challenges in clinical routine. Methods We performed a review of the literature focused on LMS in GBM. MEDLINE and EMBASE databases were queried from 1989 to 2019 for articles describing diagnosis and therapeutic options in GBM LMS, as well as risk factors and pathogenic mechanisms. Results We retrieved 155 articles, including retrospective series, case reports, and early phase clinical trials, as well as preclinical studies. These articles confirmed that LMS in GBM remains (a) a diagnostic challenge with cytological proof of LMS obtained in only 35% of cases and (b) a therapeutic challenge with a median overall survival below 2 months with best supportive care alone. For patients faced with suggestive clinical symptoms, whole neuroaxis magnetic resonance imaging and cerebrospinal fluid analysis are both recommended. Liquid biopsies are under investigation and may help prompt a reliable diagnosis. Based on the literature, a multimodal and personalized therapeutic approach of LMS, including surgery, radiotherapy, systemic cytotoxic chemotherapy, and intrathecal chemotherapies, may provide benefits to selected patients. Interestingly, molecular targeted therapies appear promising in case of actionable molecular target and should be considered. Conclusion As the prognosis of glioblastoma is improving over time, LMS becomes a more common complication. Our review highlights the need for translational studies and clinical trials dedicated to this challenging condition in order to improve diagnostic and therapeutic strategies. Implications for Practice This review summarizes the diagnostic tools and applied treatments for leptomeningeal spread, a complication of glioblastoma, as well as their outcomes. The importance of exhaustive molecular testing for molecular targeted therapies is discussed. New diagnostic and therapeutic strategies are outlined, and the need for translational studies and clinical trials dedicated to this challenging condition is highlighted.

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