Intradural extramedullary metastasis: a review of literature and case report

Land, Charles F.; Bowden, Blake D.; Morpeth, Brice G.; DeVine, John G.

doi:10.1038/s41394-019-0181-0

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…The prognosis of subdural metastatic disease is not well studied but generally considered relatively poor, mainly because subdural metastases are indicative of widespread metastatic disease [17] . No large studies of patients with subdural metastases have been performed, but one study of 22 patients with intramedullary spinal cord metastases, which are more common than subdural disease, found a median survival time of 11.6 months [18] .…”

Section: Discussionmentioning

confidence: 99%

Subdural spinal metastases detected on CT myelography: A case report and brief review

Madhavan

Eckel

Carr

et al. 2021

Radiology Case Reports

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Spinal metastases are most commonly osseous and may extend to the epidural space. Less commonly, spinal metastases can be subdural, leptomeningeal, or intramedullary. Among these, subdural metastases are the most rare, with few reported cases. While these lesions are now almost exclusively detected on MRI, they can rarely be apparent on other modalities. It is important to recognize subdural metastases on any modality, because they have a significant impact on patient prognosis and treatment. We report a case of renal cell carcinoma in a 68-year-old male initially presenting with subdural metastases detected on CT myelography, with subsequent confirmation by MRI. The case illustrates, to our knowledge, the first example of subdural metastatic disease seen on CT myelography.

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Section: Discussionmentioning

confidence: 99%

Subdural spinal metastases detected on CT myelography: A case report and brief review

Madhavan

Eckel

Carr

et al. 2021

Radiology Case Reports

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“… 14 , 15 , 17 Palliative surgical management is sometimes warranted in IDEM tumors for symptomatic relief and preservation of neurological function. 5 , 6 , 11 The surgical decision is often impacted by the aggressivity of the primary malignancy and overall prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there is only 1 previously published case of an IDEM metastasis involving an extradural or bony component suggestive of direct invasion. 11 …”

Section: Discussionmentioning

confidence: 99%

“…Metastasis to the vertebral column occurs in 3%–5% of all malignancies and only 6% of these vertebral metastases have an intradural component. 11 , 13 The current understanding of IDEM metastasis generally revolves around one or a combination of the 5 following mechanisms: (1) hematogenous seeding of malignant cells via the arterial system; (2) hematogenous seeding via Batson venous plexus; (3) local invasion of the dura; (4) drop metastasis or leptomeningeal spread via the subarachnoid space; and (5) spread from the perineural lymphatics. 11 It is thought that the most common mechanism is from leptomeningeal spread, because >50% of intracranial malignant tumors result in detectable neoplastic cells in the cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

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Spinal metastasis of parotid acinic cell carcinoma followed by intradural extramedullary recurrence: illustrative case

Yuan

Grassner

Fisher

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND The diagnosis and management of acinic cell carcinoma (ACC) is often challenging given its similarity to benign tumors, high incidences of late recurrence and distant metastasis, and tendency to be resistant to systemic chemotherapy. A primary parotid ACC resulting in an intradural extramedullary mass has not been reported. OBSERVATIONS The authors describe such a case that presented as a progressive cervical myelopathy 29 years after initial diagnosis. The tumor, located at the C2–C3 level, infiltrated the dura and contained both extradural and intradural components. This occurred 18 months after the incomplete resection of an extradural metastasis at the same location. LESSONS Although intracranial and extradural metastases of various primary malignancies are well reported, secondary spinal intradural malignancies are rare. As a result, there are no established guidelines for the surgical management of intradural extramedullary metastases and prognosis may be difficult to establish. In this case, treatment options were limited because systemic therapy options had been exhausted and repeated radiation to the area was not recommended. We report on this case to highlight the clinical course of a rare local recurrence after spinal metastasis leading to an intradural extramedullary tumor and to show that surgical intervention can lead to improvement of neurological symptoms.

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“…Any number of mechanisms could be the cause for metastatic spread; however, etiology is irrelevant once intradural metastasis is indicated. The patient is then in an advanced disease state and prognosis is poor no matter the cause ( Land, Bowden, Morpeth, & DeVine, 2019 ). Mr. OH’s clinical picture is consistent with intradural metastasis and diagnosis was confirmed based on a lumbar puncture with positive cerebral spinal fluid for malignant cells consistent with small cell lung cancer.…”

Section: Presentationmentioning

confidence: 99%