Intradural extramedullary spinal metastasis

Abstract

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.

Intradural-Extramedullary Metastatic Tumor from Lung Cancer-A Case Report and Review

“…Two types of treatment have been reported for an intraduralextramedullary tumor, the recommended operative and nonoperative methods [4,18,31,38,45,63]. In two case studies, Perrin et al…”

“…Including our case, the total number of reported cases is now 102. Many authors have described an intradural-extramedullary metastasis as a rare metastatic condition, however, we do not consider it to be rare given the number of reported cases.Two types of treatment have been reported for an intraduralextramedullary tumor, the recommended operative and nonoperative methods [4,18,31,38,45,63]. In two case studies, Perrin et al…”

“…The overall functional improvement rate was 78%. An intradural-extramedullary metastatic tumor was expected to improve following surgery regardless of the primary tumor.For the treatment of an intradural-extramedullary metastatic tumor, some reports recommended surgery [18,31,45,63] and some recommended non-surgical methods [4,38]. Of 102 cases, including ours, 94 received surgery.…”

“…Lung cancer was 24 cases [4,5,9,15,22,31,51,55,56,59,63,67, present case]. Breast cancer was 18 cases [4,5,7,8,11,13,14,16,22,24,41,57,61]. Renal cell cancer (including Wilm's tumor and Grawitz tumor) was 15 cases [25,27,35,38,43,[45][46][47]49,52,54,58,[64][65][66].…”

“…In a total of 1215 cases of primary lung cancer in an autopsy study, 20 (1.65%) revealed intradural parenchymal involvement [3]. Among 200 patients treated for symptomatic spinal metastases, a localized intradural extramedullary tumor was discovered in 10 cases [4]. Among 136 patients who underwent surgery for spinal metastases, an intradural extramedullary tumor was observed in two cases (1.5%) [5].…”