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Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications—a multicenter study

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Abstract

Intramedullary spinal cord metastasis (ISCM) is a rare event in the course of advanced malignancy. Management of these lesions remains controversial. Recently, surgery for ISCM has been advocated for selected patients. We performed a retrospective analysis of the clinical course, complications, and outcome of 30 patients surgically treated for ISCM. Patients’ age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and postoperative neurological status, and extent of the tumor resection were also analyzed. Predominant tumor location was thoracic, followed by cervical and conus medullaris. Lung cancer constituted the majority of primary malignancies. In 9 cases, one of the indications for spinal surgery was to obtain a histopathological diagnosis. On admission, all patients presented with neurological symptoms suggestive of myelopathy. After surgery, 18 patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits; 6 patients were unchanged, while 6 patients exhibited postoperative deterioration. Median survival time after surgery was 9.9 months. Age > 70 years old, presence of systemic metastases, preoperative neurological non functional status, and lung cancer as primary tumor were all factors associated with a worse survival prognosis. This study did not show a clear survival difference between gross total and subtotal ISCM tumor resection. Patients who underwent gross total resection had a worse functional outcome with respect to patients with only partial resection. Gross total resection with low morbidity must be the surgical target, but when not possible, subtotal resection and adjuvant therapy are a valid therapeutic option.

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References

  1. Bagley CA, Gokaslan ZL (2004) Cauda equina syndrome causedby primary and metastatic neoplasm. Neurosur Focus 16(6):e3

    Article  Google Scholar 

  2. Callovini GM, Bolognini A, Giordano M, Gazzeri R (2017) Surgical considerations for intramedullary conus medullaris metastatic tumors with origin from primary lung lesions: a review of the literature. Neurol India 65(1):211–214

    PubMed  Google Scholar 

  3. Connolly ES Jr, Winfree CJ, McCormick PC, Cruz M, Stein BM (1996) Intramedullary spinal cord metastasis: report of three cases and review of the literature. Surg Neurol 46:329–337

    Article  Google Scholar 

  4. Costigan D, Winkelman MD (1985) Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases. J Neurosurg 62:227–233

    Article  CAS  Google Scholar 

  5. Dam-Hieu P, Seizeura R, Mineoa F, Metgesb JP, Meriot P, Simonb H (2009) Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 111(1):10–17

    Article  Google Scholar 

  6. Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M (2009) Intramedullary lesions of conus medullaris: differential diagnosis and surgical management. Neurosurg Rev 32:287–301

    Article  Google Scholar 

  7. Edelson RN, Deck MD, Posner JB (1972) Intramedullary spinal cord metastases. Clinical and radiographic findings in nine cases. Neurology 22:1222–12231

    Article  CAS  Google Scholar 

  8. Faillot T, Roujeau T, Dulou R, Chedru F (2002) Intramedullary spinal cord metastasis: is there a place for surgery? Case report and review of the literature. Neurochirurgie 48:533–536

    PubMed  CAS  Google Scholar 

  9. Farrokh D, Fransen P, Faverly D (2001) MR findings of a primary intramedullary malignant melanoma: case report and literature review. AJNR 22:1864–1866

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Gasser TG, Pospiech J, Stolke D, Schwechheimer K (2001) Spinal intramedullary metastases. Report of two cases and review of the literature. Neurosurg Rev 24:88–92

    Article  CAS  Google Scholar 

  11. Gasser T, Sendalcioglu IE, El Hamalawi B, van de Nes JAP, Stolke D, Wiedemayer H (2005) Surgical treatment of intramedullary spinal cord metastasis of systemic cancer: functional outcome and prognosis. J Neuroncol 73:163–168

    Article  CAS  Google Scholar 

  12. Gazzeri R, Galarza M, Faiola A, Gazzeri G (2006) Pure intramedullary spinal cord metastasis secondary to gastric cancer. Neurosurg Rev 2:173–177

    Article  Google Scholar 

  13. Gazzeri R, Faiola A, Laszlo A, Callovini G, Galarza M. (2020) Intraoperative electrophysiological monitoring (TES and EMG) in spinal tumor surgery. in Spinal Cord and Spinal Column Tumors. Editors: Landi, Gregori and Delfini. Nova Publisher; 14, pp 217–228.

  14. Gazzeri R, Faiola A, Neroni M, Fiore C, Callovini G, Pischedda M, Galarza M (2013) Safety of intraoperative electrophysiological monitoring (TES and EMG) for spinal and cranial lesions. Surg Technol Int. 23:296–306

    PubMed  Google Scholar 

  15. Goyal A, Yolcu Y, Kerezoudis P, Alvi MA, Krauss W, Bydon M (2019) Intramedullary spinal cord metastases: an istitutional review of survival and outcomes. J Neuro-Oncol 142(2):347–354

    Article  CAS  Google Scholar 

  16. Guppy KH, Wagner F (2006) Metastasis to the conus medullaris: case report. Neurosurgery 59(5):1164–1168

    Article  Google Scholar 

  17. Jellinger K, Kothbauer P, Sunder-Plassmann E, Weiss R (1979) Intramedullary spinal cord metastases. J Neurol 220:31–41

    Article  CAS  Google Scholar 

  18. Jin SH, Chung CK, Kim CH, Choi YD, Kwak G, Kim BE (2015) Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery. Acta Neurochir (Wien) 157(12):2149–2155

    Article  Google Scholar 

  19. Kalayci M, Cagavi F, Gul S, Yenidunia S, Acikgoz B (2004) Intramedullary spinal cord metastases: diagnosis and treatment-an illustrated review. Acta Neurochir 146:1347–1354

    Article  CAS  Google Scholar 

  20. Lee SS, Kim MK, Sym SJ, Kim WK, Kim SB (2007) Intramedullary spinal cord metastases: a single-institution experience. J Neurooncol 84:85–89

    Article  Google Scholar 

  21. Lv J, Liu B, Quan X, Li C, Dong L, Liu M (2019) Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review. Onco Targets Ther 21(12):4741–4753

    Article  Google Scholar 

  22. Majmundar N, Sho B, Assina B (2018) Lung adenocarcinoma presenting as intramedullary spinal cord metastasis: case report and review of literature. J Clin Neurosci 52:124–131

    Article  Google Scholar 

  23. McCormick PC, Torres R, Post KD (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532

    Article  CAS  Google Scholar 

  24. Payer S, Mende KC, Pract M, Westhal M, Eiker SO (2015) Intramedullary spinal cord metastasis: an increasingly common diagnosis. Neurosurg Focus 39(2):E15

    Article  Google Scholar 

  25. Potti A, Abdel-Raheem M, Levitt R, Shell DA, Medhi SA (2001) Intramedullary spinal cord metastasis (ISCM) and no small cell lung carcinoma (NSCLC): clinical patterns, diagnosis and therapeutic considerations. Lung Cancer 31:319–323

    Article  CAS  Google Scholar 

  26. Rauschenbach L (2020) Spinal cord tumor microenvironment. Adv Exp Med Biol. 1226:97–109

    Article  CAS  Google Scholar 

  27. Shan Sung W, Jo Sung M, Ho Chan J, Manion B, Song J, Dubey A, Erasmus A (2013) Intramedullary spinal cord metastases: a 20-years institutional experience with a comprehensive literature review. World Neurosurg 79:576–584

    Article  Google Scholar 

  28. Shiff D, O’Neill BP (1998) Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 647:906–912

    Google Scholar 

  29. Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A, Erasmus A, Hunn A (2013) Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg. 79(3-4):576–584

    Article  Google Scholar 

  30. Sutter B, Arthur A, Laurent J, Chadduck J, Friehs G, Clarici G, Pendl G (1998) Treatment options and time course for intramedullary spinal cord metastasis. Report of three cases and review of the literature. Neurosurg Focus 4(5):e3

    Article  CAS  Google Scholar 

  31. Tognetti FLG, Calbucci F (1988) Metastases of the spinal cord from remote neoplasms. World Neurosurg 30:220–227

    CAS  Google Scholar 

  32. Winkelman MD, Adelstein CF, Shmookler B, Heffess CS (1998) Thyroid papillary carcinoma of columnar cell type: a clinicopathologic study of 16 cases. Cancer 82(4):740–753

    Article  Google Scholar 

  33. Wostrack M, Pape H, Kreutzer J, Ringel F, Meyer B, Stoffel M (2012) Surgical treatment of spinal intradural carcinoma metastases. Acta Neurochir 154:349–35715

    Article  Google Scholar 

  34. Wostrack M, Pape H, Kreutzer J, Ringel F, Meyer B, Stoffel M (2012) Conus medullaris and cauda equina tumors: clinical presentation, prognosis, and outcome after surgical treatment: clinical article. Acta Neurochir (Wien) 154(2):349–357

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, San Giovanni–Addolorata Hospital, Rome, Italy

    Roberto Gazzeri & Giorgio Maria Callovini

  2. Department of Neurosurgery, IRCCS Istituto Nazionale Tumori “Regina Elena”, Rome, Italy

    Roberto Gazzeri & Stefano Telera

  3. Regional Service of Neurosurgery, “Virgen de la Arrixaca” University Hospital, Murcia, Spain

    Marcelo Galarza

  4. Department of Biostatistics, IRCCS Istituto Nazionale Tumori “Regina Elena”, Rome, Italy

    Sperduti Isabella

  5. Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

    Alex Alfieri

  6. Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany

    Alex Alfieri

Authors
  1. Roberto Gazzeri
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  2. Stefano Telera
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  3. Marcelo Galarza
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  4. Giorgio Maria Callovini
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  5. Sperduti Isabella
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  6. Alex Alfieri
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Contributions

Conception and design: Gazzeri. Acquisition of data: Gazzeri, Callovini, Alfieri, Galarza, Telera. Drafting the article: Gazzeri. Statistical analysis: Sperduti. Study supervision: Gazzeri.

Corresponding author

Correspondence to Roberto Gazzeri.

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The study was approved by the Central Ethical Committee IRCCS Lazio (n. reg. 1356/20).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Gazzeri, R., Telera, S., Galarza, M. et al. Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications—a multicenter study. Neurosurg Rev 44, 3267–3275 (2021). https://doi.org/10.1007/s10143-021-01491-8

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  • DOI: https://doi.org/10.1007/s10143-021-01491-8

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