Roberto Gazzeri1,2, Stefano Telera3, Marcelo Galarza4, Giorgio Maria Callovini5, Isabella Sperduti6, Alex Alfieri7,8. 1. Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy. robertogazzeri@gmail.com. 2. Department of Pain Therapy, San Giovanni-Addolorata Hospital, Rome, Italy. robertogazzeri@gmail.com. 3. Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy. 4. Regional Service of Neurosurgery, "Virgen de La Arrixaca" University Hospital, Murcia, Spain. 5. Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy. 6. Department of Biostatistics, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy. 7. Cantonal Hospital Winterthur, Winterthur, Switzerland. 8. Neurosurgery, Faculty of Health Sciences, The Brandenburg Medical School Theodor Fontane, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, The University of Potsdam, Potsdam, Germany.
Abstract
PURPOSE: Intradural extramedullary spinal metastases (IESM) represent an extremely rare manifestation of systemic cancer. We evaluated the surgical indications, complications and outcome in a series of 43 patients with solitary intradural extramedullary metastases originating from solid cancer of non-neurogenic origin. METHODS: Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and post-operative neurological status, extent of the tumor resection were also analyzed. RESULTS: The majority of IEMS occurred in the thoracic area, with the most common presenting symptoms ranging from motor (76.7%) to sensory (72%) deficits. Gross total resection was achieved in 55.8% of cases, while In 44.2% of patients a subtotal resection was performed due to strong adherence between the tumor and neural tissue. After surgery, 72.1% of patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits, while neurologic functional status was severely affected postoperatively in 3 patients. CONCLUSION: Although there was no statistical significance between the different parameters and overall survival, KPS and the presence of other metastases were the strongest prognostic factors for overall survival and postoperative neurologic outcome.
PURPOSE: Intradural extramedullary spinal metastases (IESM) represent an extremely rare manifestation of systemic cancer. We evaluated the surgical indications, complications and outcome in a series of 43 patients with solitary intradural extramedullary metastases originating from solid cancer of non-neurogenic origin. METHODS: Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and post-operative neurological status, extent of the tumor resection were also analyzed. RESULTS: The majority of IEMS occurred in the thoracic area, with the most common presenting symptoms ranging from motor (76.7%) to sensory (72%) deficits. Gross total resection was achieved in 55.8% of cases, while In 44.2% of patients a subtotal resection was performed due to strong adherence between the tumor and neural tissue. After surgery, 72.1% of patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits, while neurologic functional status was severely affected postoperatively in 3 patients. CONCLUSION: Although there was no statistical significance between the different parameters and overall survival, KPS and the presence of other metastases were the strongest prognostic factors for overall survival and postoperative neurologic outcome.