title: BRCA2-positive spinal intramedullary ovarian metastatic disease: case report.
abstract: BACKGROUND
  Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread.
  
  
  OBJECTIVE
  The authors discuss the management and surgical decision making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature.
  
  
  METHODS
  A case report was used.
  
  
  METHODS
  The authors describe a case of a 59-year-old woman with Breast Cancer gene (BRCA) 2-positive ovarian cancer who developed progressive myelopathy from a T10 to T11 intramedullary metastatic lesion.
  
  
  RESULTS
  The patient underwent a standard open T10-T11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative magnetic resonance imaging at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease 1 year after surgery.
  
  
  CONCLUSIONS
  Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurologic deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Mazur
authors.affiliation: Department of Pathology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Driscoll
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: McEvoy
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D024522:Genes, BRCA2; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000235:genetics / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D013904:Thoracic Vertebrae
keywords: BRCA2; Intramedullary; Metastatic; Ovarian cancer; Spine; Surgery