Retrospective study of 19 patients with intramedullary spinal cord metastasis
Received 24 January 2008; received in revised form 21 June 2008; accepted 30 June 2008.
Abstract
Object
Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival.
Patients and methods
We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed.
Results
Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients.
Conclusions
Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.
aDepartment of Neurosurgery, University of Bretagne Occidentale, School of Medicine and University Medical Center, F 29609 Brest, France
bDepartment of Oncology, University of Bretagne Occidentale, School of Medicine and University Medical Center, F 29609 Brest, France
cDepartment of Neuroradiology, University of Bretagne Occidentale, School of Medicine and University Medical Center, F 29609 Brest, France
Corresponding author at: Department of Neurosurgery, University Medical Center, Bd Tanguy-Prigent, F29609 Brest, France. Tel.: +33 298 347 689; fax: +33 298 342 337.
ABSTRACT