Abstract
Objective: Intramedullary spinal cord metastases (ISCM) of systemic cancer are rare. To date, patients with ISCM tend to benefit only to a limited extend from surgery and adjuvant therapy. Subject of this investigation is to assess predictive factors for surgical outcome and survival and to evaluate the value of surgical radicality in the treatment of ISCM. Patients and methods: Between 1990 and 2004, a series of 146 patients with intramedullary tumors underwent surgical treatment in our institution. Among these, 13 patients with intramedullary cancer metastases (7 adenocarcinomas, 3 poorly differentiated carcinomas, 3 sarcomas) were identified. Standard microsurgical removal of the ISCM was performed. Functional outcome was graded according to a standardized scale and factors influencing outcome and survival were statistically analyzed. Results: Median progression-free survival was 13 weeks and median overall survival was 31 weeks. In 5 patients (38) the intramedullary lesion was the initial manifestation of the malignant disease. All poorly differentiated carcinomas and all sarcomas were resected incompletely. Surgical radicality presented a negative predictive factor for functional outcome, increasing radicality leading to functional deterioration. Age, sex, tumor localization, surgical radicality and the presence of neoplastic meningeosis did not affect survival. Conclusion: Surgery of ISCM can be performed with an acceptable operative morbidity. Radicality depended on tumor histology. However, radical tumor removal did not affect survival and was correlated with a poor functional outcome. Therefore, complete surgical removal of ISCM should only be intended in patients in whom an unproblematic excision is feasible.
Similar content being viewed by others
References
ES Connolly SuffixJr CJ Winfree PC McCormick M Cruz BM. Stein (1996) ArticleTitleIntramedullary spinal cord metastasis: report of three cases and review of the literature Surg Neurol 46 329–337 Occurrence Handle8876713
KD Barron A Hirano S Araki RD. Terry (1959) ArticleTitleExperiences with metastatic neoplasms involving the spinal cord Neurology 9 91–106 Occurrence Handle1:STN:280:CyaD2M3ksVU%3D Occurrence Handle13622902
JB. Posner (1971) ArticleTitleNeurological complications of systemic cancer Med Clin North Am 55 625–646 Occurrence Handle1:STN:280:CS6C1cbpvVY%3D Occurrence Handle4325095
JW Dunne CG Harper R. Pamphlett (1986) ArticleTitleIntramedullary spinal cord metastases: a clinical and pathological study of nine cases Q J Med 61 1003–1020 Occurrence Handle1:STN:280:BieD3MnotVM%3D Occurrence Handle3659245
M Fornari F Pluchino CL Solero S Giombini G Luccarelli G Oliveri G. Lasio (1988) ArticleTitleMicrosurgical treatment of intramedullary spinal cord tumours Acta Neurochir Suppl 43 3–8 Occurrence Handle1:STN:280:BiaC3c3ns1U%3D
GJ Loughrey CD Collins SM Todd NM Brown RJ. Johnson (2000) ArticleTitleMagnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy Clin Radiol 55 849–855 Occurrence Handle10.1053/crad.2000.0547 Occurrence Handle1:STN:280:DC%2BD3M7hvVyhtw%3D%3D Occurrence Handle11069740
T Ijaz K. Jones (1997) ArticleTitleImages in clinical medicine Intramedullary spinal cord metastases. New Engl J Med 336 768 Occurrence Handle1:STN:280:ByiB3c7jslQ%3D
S Constantini DC Miller JC Allen LB Rorke D Freed FJ. Epstein (2000) ArticleTitleRadical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults J Neurosurg 93 183–193 Occurrence Handle1:STN:280:DC%2BD3cvltlOqtA%3D%3D
PR. Cooper (1989) ArticleTitleOutcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients Neurosurgery 25 855–859
HL. Frankel (1969) ArticleTitleAscending cord lesion in the early stages following spinal injury Paraplegia 7 111–118 Occurrence Handle1:STN:280:CCaB2sfns10%3D Occurrence Handle5806661
A Catz E Greenberg M Itzkovich V Bluvshtein J Ronen I. Gelernter (2004) ArticleTitleA new instrument for outcome assessment in rehabilitation medicine: spinal cord injury ability realization measurement index Arch Phys Med Rehabil 85 399–404 Occurrence Handle10.1016/S0003-9993(03)00475-1 Occurrence Handle15031824
H Wiedemayer B Fauser IE Sandalcioglu H Schafer D. Stolke (2002) ArticleTitleThe impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases J Neurosurg 96 255–262 Occurrence Handle11838799
H Wiedemayer H Schaefer W Armbruster M Miller D. Stolke (2002) ArticleTitleObservations on intraoperative somatosensory evoked potential (SEP) monitoring in the semi-sitting position Clin Neurophysiol 113 1993–1997 Occurrence Handle10.1016/S1388-2457(02)00302-4 Occurrence Handle12464339
A Kaplan P. Meier (1958) ArticleTitleNonparametric estimation from incomplete observation J Am Stat Assoc 53 457–481
RN Edelson MD Deck JB. Posner (1972) ArticleTitleIntramedullary spinal cord metastases. Clinical and radiographic findings in nine cases. Neurology 22 1222–1231 Occurrence Handle1:STN:280:CSyD1MnhtFU%3D Occurrence Handle4346871
K Jellinger P Kothbauer E Sunder-Plassmann R. Weiss (1979) ArticleTitleIntramedullary spinal cord metastases J Neurol 220 31–41 Occurrence Handle10.1007/BF00313146 Occurrence Handle1:STN:280:CSaC3M7itlc%3D Occurrence Handle84065
DA Costigan MD. Winkelman (1985) ArticleTitleIntramedullary spinal cord metastasis A clinicopathological study of 13 IssueIDcases. J Neurosurg 62 227–233
JL Grem J Burgess DL. Trump (1985) ArticleTitleClinical features and natural history of intramedullary spinal cord metastasis Cancer 56 2305–2314 Occurrence Handle1:STN:280:BimD38jntlQ%3D Occurrence Handle4052974
D Schiff BP. O’Neill (1996) ArticleTitleIntramedullary spinal cord metastases: clinical features and treatment outcome Neurology 47 906–912 Occurrence Handle1:STN:280:ByiD3M%2FmvVA%3D Occurrence Handle8857717
R. Amin (1999) ArticleTitleIntramedullary spinal metastasis from carcinoma of the cervix Br J Radiol 72 89–91 Occurrence Handle1:STN:280:DyaK1M3ntlansQ%3D%3D Occurrence Handle10341697
OE Schijns E Kurt P Wessels GJ Luijckx EA. Beuls (2000) ArticleTitleIntramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature Clin Neurol Neurosurg 102 249–254 Occurrence Handle10.1016/S0303-8467(00)00106-2 Occurrence Handle1:STN:280:DC%2BD3M7ktVKgtg%3D%3D Occurrence Handle11154816
S Taniura K Tatebayashi K Watanabe T. Watanabe (2000) ArticleTitleIntramedullary spinal cord metastasis from gastric cancer Case report. J Neurosurg 93 145–147 Occurrence Handle1:STN:280:DC%2BD3czjs1Whsg%3D%3D
TG Gasser J Pospiech D Stolke K. Schwechheimer (2001) ArticleTitleSpinal intramedullary metastases. Report of two cases and review of the literature. Neurosurg Rev 24 88–92 Occurrence Handle1:STN:280:DC%2BD38%2FisVahsA%3D%3D Occurrence Handle11485245
U Schick G Marquardt R. Lorenz (2001) ArticleTitleIntradural and extradural spinal metastases Neurosurg Rev 24 1–5 Occurrence Handle1:STN:280:DC%2BD3MrjslCgsw%3D%3D Occurrence Handle11339461
G Torrealba S Del Villar C Barzallo R Gerjman L. Yanez (2001) ArticleTitleSpinal cord metastasis: an uncommon location. Experience in 2 cases. Rev Med Chil 129 1445–1448 Occurrence Handle1:STN:280:DC%2BD38zjvVygsg%3D%3D Occurrence Handle12080882
C Kosmas NA Malamos S Stefanou A Gregoriou N. Tsavaris (2002) ArticleTitleIntramedullary spinal cord metastases in breast carcinoma: report of two cases and review of the literature J Chemother 14 631–634 Occurrence Handle1:STN:280:DC%2BD3s%2Fnt1Gmug%3D%3D Occurrence Handle12583557
T Faillot T Roujeau R Dulou JL Blanc F. Chedru (2002) ArticleTitleIntramedullary spinal cord metastasis: is there a place for surgery? Case report and review of literature Neurochirurgie 48 533–536 Occurrence Handle1:STN:280:DC%2BD3s%2FosVeltQ%3D%3D Occurrence Handle12595811
P Reddy S Sathyanarayana R Acharya A. Nanda (2003) ArticleTitleIntramedullary spinal cord metastases: case report and review of literature J La State Med Soc 155 44–45 Occurrence Handle12656274
HE Aryan A Farin P Nakaji SG Imbesi BB. Abshire (2004) ArticleTitleIntramedullary spinal cord metastasis of lung adenocarcinoma presenting as Brown-Sequard syndrome Surg Neurol 61 72–76 Occurrence Handle10.1016/S0090-3019(03)00298-2 Occurrence Handle14706385
H Okamoto T Shinkai Y Matsuno N. Saijo (1993) ArticleTitleIntradural parenchymal involvement in the spinal subarachnoid space associated with primary lung cancer Cancer 72 2583–2588 Occurrence Handle1:STN:280:ByuD3cngslY%3D Occurrence Handle8402479
T Rajendra K Ann Lee J Thomas A Hong C. Chan (2003) ArticleTitleResults of surgical treatment for cerebral metastases J Clin Neurosci 10 190–194 Occurrence Handle10.1016/S0967-5868(02)00127-3 Occurrence Handle12637047
A Jawahar F Ampil C Wielbaecher GH Hartman JH Zhang A. Nanda (2004) ArticleTitleManagement strategies for patients with brain metastases: has radiosurgery made a difference? South Med J 97 254–258 Occurrence Handle10.1097/01.SMJ.0000060569.47897.75 Occurrence Handle15043332
JN Cormier RE. Pollock (2004) ArticleTitleSoft tissue sarcomas CA Cancer J Clin 54 94–109 Occurrence Handle15061599
S Constantini J Houten DC Miller D Freed MM Ozek LB Rorke JC Allen FJ. Epstein (1996) ArticleTitleIntramedullary spinal cord tumors in children under the age of 3 years J Neurosurg 85 1036–1043 Occurrence Handle1:STN:280:ByiD1czltlA%3D Occurrence Handle8929492
Simeone FA. (1990). Spinal cord tumors in adults. In: Neurological Surgery (3rd edn.), edited by JR . Youmans Saunders, Philadelphia. pp. 3531–3547
G Kopelson RM Linggood GM Kleinman J Doucette CC. Wang (1980) ArticleTitleManagement of intramedullary spinal cord tumors Radiology 135 473–479 Occurrence Handle1:STN:280:Bi%2BC28jptFM%3D Occurrence Handle7367644
MD Winkelman DJ Adelstein NL. Karlins (1987) ArticleTitleIntramedullary spinal cord metastasis Diagnostic and therapeutic considerations. Arch Neurol 44 526–531 Occurrence Handle1:STN:280:BiiB3M3mvV0%3D
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gasser, T., Sandalcioglu, I.E., Hamalawi, B.E. et al. Surgical treatment of intramedullary spinal cord metastases of systemic cancer: functional outcome and prognosis. J Neurooncol 73, 163–168 (2005). https://doi.org/10.1007/s11060-004-4275-5
Issue Date:
DOI: https://doi.org/10.1007/s11060-004-4275-5