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.

中文翻译：

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非神经源性实体癌孤立性硬膜内髓外脊髓转移瘤的手术治疗。一项多中心研究

目的

硬膜内髓外脊柱转移瘤 (IESM) 是一种极为罕见的全身性癌症表现。我们评估了一系列 43 例来自非神经源性实体癌的孤立性硬膜内髓外转移患者的手术适应症、并发症和结果。

方法

收集患者的年龄、原发癌的组织病理学诊断、肿瘤大小、脊柱位置和髓外肿瘤播散情况。还分析了术前功能状态、术前和术后神经系统状态、肿瘤切除范围。

结果

大多数 IEMS 发生在胸部，最常见的症状从运动 (76.7%) 到感觉 (72%) 缺陷不等。55.8% 的病例实现了总切除，而在 44.2% 的患者中，由于肿瘤和神经组织之间的强粘附性，进行了次全切除。术后 72.1% 的患者在疼痛缓解和运动和/或感觉障碍部分恢复方面表现出症状改善，而 3 例患者术后神经功能状态受到严重影响。

结论

尽管不同参数和总生存期之间没有统计学意义，但 KPS 和其他转移灶的存在是总生存期和术后神经系统结果的最强预后因素。