title: Intramedullary spinal cord metastases: an increasingly common diagnosis.
abstract: OBJECT Intramedullary spinal cord metastases (ISCM) represent a small proportion of intramedullary tumors. However, with the lifespans of patients with malignant tumors increasing, incidents of ISCM are on the rise. Due to threateningly severe disabilities in patients, accompanied by limited life expectancy, every attempt should be made to treat these tumors the same way as metastases elsewhere in the CNS, with the goal of complete removal of the ISCM and preservation of neurological functions. The object of this study is to retrospectively analyze the experiences of 22 patients who were surgically treated for ISCM over a 22-year period. METHODS Hospital charts of 22 patients, who were surgically treated for ISCM between 1992 and 2014, were reviewed retrospectively. Demographic data, histopathological diagnoses of primary cancer, chronological sequence of the disease, and neurological status using the simplified McCormick functional classification were collected and reanalyzed. RESULTS The most frequent histology was metastasis of lung cancer, followed by brain and breast cancers. The time span from primary cancer diagnosis to the development of symptomatic spinal metastases ranged from 0 to 285 months, with a mean interval of 38 months. The leading presenting sign was dysesthesia (77% of the population), followed by paresis (68%). Only 5 patients (23%) showed urinary retention. Initial performance status represented by the McCormick Scale was on average 2.47. Total or near-total removal was achieved in 87% of cases. Compared with the clinical status 1-2 days after surgery, there was an improvement in the McCormick Scale grade at the last follow-up from 2.47 to 2.12 (p = 0.009). Likewise, an improvement was detected when comparing the preoperative status with the last follow-up (from 2.45 to 2.12; p = 0.029). The mean survival time after surgery was 11.6 months. CONCLUSIONS These results suggest that surgery for intramedullary metastases-with all of the challenges of a rare and potentially risky procedure-can be beneficial to patients with advanced stages of cancer. Surgery can be performed with minimal new morbidity and results in maintaining neurological performance status.
authors.affiliation: Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Payer
authors.affiliation: Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Klaus Christian
authors.initials: KC
authors.lastname: Mende
authors.affiliation: Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany.
authors.forename: Sven O
authors.initials: SO
authors.lastname: Eicker
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications; D001943:Breast Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000556:secondary* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: CUP = cancer of unknown primary; CUSA = Cavitron ultrasonic surgical aspirator; IOM = intraoperative monitoring; ISCM = intramedullary spinal cord metastases; intramedullary metastases; intramedullary spinal cord metastases; spinal cord