Abstract
Background
Compressive intradural metastases of the cauda equina are a rare site of metastatic spread in systemic cancer. So far, only few reports have been published with conflicting statements concerning a surgical versus nonsurgical approach.
Method
Five patients with symptomatic space-occupying intradural metastases of the cauda equina were analyzed retrospectively, focusing on the influence of surgical intervention on pain relief, neurological outcome and thus the patients’ quality of life.
Findings
At the time of diagnosis, all patients were in an advanced metastatic state. Surgical resection was the primary treatment in four patients and radiotherapy in one. Despite infiltration of the cauda rootlets, gross total tumour resection could be achieved in two of the four patients treated surgically. Functional outcome was beneficial in these patients with marked and immediate relief of pain and improvement of motor function even following incomplete tumour resection.
Conclusions
Surgical treatment of compressive intradural metastases of the cauda equina seems to be feasible with low operative risk and with the potential benefit of an immediate relief of pain and improvement in motor function and thus an increase in quality of life.
Similar content being viewed by others
References
Alfieri A, Mazzoleni G, Schwarz A, Campello M, Broger M, Vitale M, Vigl EE (2005) Renal cell carcinoma and intradural spinal metastasis with cauda equina infiltration: case report. Spine 30:161–163. doi:10.1097/01.brs.0000149180.75701.d1
Alfieri A, Mazzoleni G, Schwarz A, Campello M, Broger M, Vitale M, Vigl EE (2005) Renal cell carcinoma and intradural spinal metastasis with cauda equina infiltration: case report—part II. Spine 30:260–262. doi:10.1097/01.brs.0000149180.75701.d1
Batson OV (1942) The role of the vertebral veins in metastatic processes. Ann Intern Med 16:38–42
Benzil DL, Saboori M, Mogilner AY, Mogilner AY, Rocchio R, Moorthy CR (2004) Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg 101(Suppl 3):413–418
Bernard I, Favier T, Menei P, Fournier D, Alhayek G, Mercier P, Guy G (1993) Les métastases de la queue de cheval des cancers visceraux. Rev Rhum 60:172–175
Bilsky MH, Lis E, Raizer J, Lee H, Boland P (1999) The diagnosis and treatment of metastatic spinal tumor. Oncologist 4:459–469
Cho DY, Wang YC, Chen JT (1995) Intradural metastasis to the cauda equina from carcinoma of the anus. Spine 20:2341–2344. doi:10.1097/00007632-199511000-00014
Chow TSF, McCutcheon IE (1996) The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment. J Neurosurg 85:225–230
Coutinho LMB, Teixeira JLC (1976) Metastase de carcinoma comprometendo a cauda equina. Arq Neuro-Psiquiatr 34:288–292
Fearnside MR, Adams CBT (1978) Tumours of the cauda equina. J Neurol Neurosurg Psychiatry 41:24–31. doi:10.1136/jnnp.41.1.24
Frey I, LeBreton C, Lefkopoulos A, Perrot N, Khalil A, Chopier J, LeBlanche A, Bigot JM (1998) Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Eur Radiol 8:1187–1192. doi:10.1007/s003300050532
Gaetani P, Di Ieva A, Colombo P, Tancioni F, Aimar E, Debernardi A, Rodriguez Y, Baena R (2004) Intradural spinal metastasis of renal clear cell carcinoma causing cauda equina syndrome. Acta Neurochir (Wien) 146:857–861. doi:10.1007/s00701-004-0299-z
Grossman SA, Krabak MJ (1999) Leptomeningeal carcinomatosis. Cancer Treat Rev 25:103–119. doi:10.1053/ctrv.1999.0119
Hargraves RW, Cotelingam JD, Harris RD, Pulliam MW (1986) Unusual metastasis to the cauda equina: case report. Neurosurgery 19:828–830. doi:10.1097/00006123-198611000-00020
Hirabayashi H, Ebara S, Kinoshita T, Yuzawa Y, Nakamura I, Takahashi J, Kamimura M, Ohtsuka K, Takaoka K (2003) Clinical outcome and survival after palliative surgery for spinal metastases. Cancer 97:476–484. doi:10.1002/cncr.11039
Hirsh LF, Finneson BE (1978) Intradural sacral nerve root metastasis mimicking herniated disc. J Neurosurg 49:764–768
Kokkoris CP (1983) Leptomeningeal carcinomatosis. How does cancer reach the pia-arachnoid. Cancer 51:154–160. doi:10.1002/1097-0142(19830101)51:1<154::AID-CNCR2820510130>3.0.CO;2-K
Kotil K, Kilinc BM, Bilge T (2007) Spinal metastasis of occult lung carcinoma causing cauda equina syndrome. J Clin Neurosci 14:372–375. doi:10.1016/j.jocn.2006.01.007
Kubota M, Saeki N, Yamaura A, Iuchi T, Ohga M, Osato K (2004) A rare case of metastatic renal cell carcinoma resembling a nerve sheath tumor of the cauda equina. J Clin Neurosci 11:530–532. doi:10.1016/j.jocn.2003.09.010
Mak K, Kwok C (2001) Intradural spinal metastasis from renal cell carcinoma: a case report. J Orthop Surg 9:57–61
Maxwell M, Borges LF, Zervas NT (1999) Renal cell carcinoma: a rare cause of cauda equina metastasis. J Neurosurg Spine 90:129–132
Mirimanoff RO, Choi NC (1987) Intradural spinal metastases in patients with posterior fossa brain metastases from various primary cancers. Oncology 44:232–236
Mosdal C, Bang F (1981) Intradural spinal metastases. Acta Neurochir (Wien) 56:107–110. doi:10.1007/BF01400978
Parenti G, Fiori L, Marconi F, Tusini G (1993) Primary cauda equina tumors. J Neurosurg Sci 37:149–156
Perrin RG, Livingston KE, Aarabi B (1982) Intradural extramedullary spinal metastasis. A report of 10 cases. J Neurosurg 56:835–837
Pieters RS, Niemierko A, Fullerton BC, Munzenrider JE (2006) Cauda equina tolerance to high-dose fractionated irradiation. Int J Radiat Oncol Biol Phys 64:251–257. doi:10.1016/j.ijrobp.2005.04.019
Rivano C, Borzone M, Pesce C, Pisani R (1996) Cauda equina metastasis from ovarian malignancy. Eur J Gynaecol Oncol 21:397–399
Ryu S, Jin R, Jin JY, Chen Q, Rock J, Anderson J, Movsas B (2008) Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manage 35:292–298. doi:10.1016/j.jpainsymman.2007.04.020
Sikorski CW, Pytel P, Rubin CW, Yamini B (2006) Intradural spinal Wilm’s tumor metastasis: case report. Neurosurgery 59:942–943. doi:10.1227/01.NEU.0000232663.48673.A3
Stambough JL, Reid JH, Ross MA, Simeone FA, Booth RE (1991) Isolated intradural metastasis simulating lumbar disc disease. Spine 16:581–583. doi:10.1097/00007632-199105000-00018
Stark RJ, Henson RA, Evans SJW (1982) Spinal metastases. A retrospective survey from a general hospital. Brain 105:189–213. doi:10.1093/brain/105.1.189
Takada T, Doita M, Nishida K, Miura J, Takada T, Yoshiya S, Kurosaka M (2003) Unusual metastasis to the cauda equina from renal cell carcinoma. Spine 28:E114–E117. doi:10.1097/00007632-200303150-00022
Takahashi I, Isu T, Iwasaki Y, Akino M, Takahashi A, Abe H, Kitagawa M, Kojima H, Inoue K, Saitoh H (1990) Metastatic Grawitz’s tumor to the cauda equina: case report. No Shinkei Geka 18:1157–1160
Taniura S, Taniguchi M, Mizutani T, Takahashi H (2007) Metastatic hemangiopericytoma to the cauda equina: a case report. Spine J 7:371–373. doi:10.1016/j.spinee.2006.05.011
Teh BS, Paulino AC, Lu HH, Chiu JK, Richardson S, Chiang S, Amato R, Butler EB, Bloch C (2007) Versatility of the Novalis system to deliver image-guided stereotactic body radiation therapy (SBRT) for various anatomical sites. Technol Cancer Res Treat 6:347–354
Wald SL, Roland TA (1984) Intradural spinal metastasis in Ewing’s sarcoma: case report and review of the literature. Neurosurgery 15:873–877. doi:10.1097/00006123-198412000-00019
Wippold FJ, Smirniotopoulos JG, Pilgram TK (1997) Lesions of the cauda equina: a clinical and pathology review from the Armed Forces Institute of Pathology. Clin Neurol Neurosurg 99:229–234. doi:10.1016/S0303-8467(97)00095-4
Zhu JJ, Padillo O, Duff J, Hsi BL, Fletcher JA, Querfurth H (2004) Cavernous sinus and leptomeningeal metastases arising from a squamous cell carcinoma of the face: case report. Neurosurgery 54:492–498. doi:10.1227/01.NEU.0000103674.30974.69
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Löhr, M., Tzouras, G., Kocher, M. et al. Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin. Acta Neurochir (Wien) 151, 207–215 (2009). https://doi.org/10.1007/s00701-009-0214-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-009-0214-8