T T Lee1, H J Landy. 1. Department of Neurological Surgery, University of Miami School of Medicine, Florida, USA.
Abstract
BACKGROUND: Spinal metastasis of intracranial meningiomas has rarely been reported. Three out of ten previously reported cases of malignant meningioma metastasizing to the spine had undergone surgical debulking with no neurological improvement. The authors retrospectively reviewed the treatment course of three patients with malignant meningioma metastasizing to the spine who underwent early magnetic resonance imaging (MRI) and radiotherapy without surgical debulking. CASE DESCRIPTION: Three patients with intracranial malignant meningiomas underwent multiple resections of intracranial lesions, and developed spinal intradural metastases an average of 64 months (range, 27-102 months) from their initial presentation. All three patients had at least two operations for recurrent intracranial tumors. All had localized back pain with motor weakness, and MRI scans demonstrated spinal involvement. No surgical exploration was performed for the spinal lesions; rather, all patients received steroids and radiotherapy for the spinal lesions. All three patients improved neurologically after the steroid and radiation treatments, and went on to survive from 3 to 18 months. CONCLUSION: Early MRI should be performed in patients with spinal symptoms and signs after the treatment of intracranial meningiomas. Radiotherapy is an effective palliative treatment for spinal metastases.
BACKGROUND: Spinal metastasis of intracranial meningiomas has rarely been reported. Three out of ten previously reported cases of malignant meningioma metastasizing to the spine had undergone surgical debulking with no neurological improvement. The authors retrospectively reviewed the treatment course of three patients with malignant meningioma metastasizing to the spine who underwent early magnetic resonance imaging (MRI) and radiotherapy without surgical debulking. CASE DESCRIPTION: Three patients with intracranial malignant meningiomas underwent multiple resections of intracranial lesions, and developed spinal intradural metastases an average of 64 months (range, 27-102 months) from their initial presentation. All three patients had at least two operations for recurrent intracranial tumors. All had localized back pain with motor weakness, and MRI scans demonstrated spinal involvement. No surgical exploration was performed for the spinal lesions; rather, all patients received steroids and radiotherapy for the spinal lesions. All three patients improved neurologically after the steroid and radiation treatments, and went on to survive from 3 to 18 months. CONCLUSION: Early MRI should be performed in patients with spinal symptoms and signs after the treatment of intracranial meningiomas. Radiotherapy is an effective palliative treatment for spinal metastases.