gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Surgical treatment of intramedullary spinal cord metastases of systemic cancer: Functional outcome and prognosis

Meeting Abstract

  • T. Gasser - Klinik für Neurochirurgie, Universität Duisburg-Essen
  • I.E. Sandalcioglu - Klinik für Neurochirurgie, Universität Duisburg-Essen
  • B. El Hamalawi - Klinik für Neurochirurgie, Universität Duisburg-Essen
  • O. Müller - Klinik für Neurochirurgie, Universität Duisburg-Essen
  • J.A.P. van de Nes - Institut für Neuropathologie, Universität Duisburg-Essen
  • U. Sure - Klinik für Neurochirurgie, Universität Duisburg-Essen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.02

DOI: 10.3205/11dgnc177, URN: urn:nbn:de:0183-11dgnc1773

Published: April 28, 2011

© 2011 Gasser et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Intramedullary spinal cord metastases (ISCM) of systemic cancer are rare. To date, patients with ISCM tend to benefit only to a limited extent from surgery and adjuvant therapy. Subject of this investigation is to assess predictive factors for the surgical outcome and survival and to evaluate the value of surgical radicality in the treatment of ISCM.

Methods: Between 1990 and 2010, a series of 230 patients with intramedullary tumors underwent surgical treatment in our institution. Among these, there were 21 patients with intramedullary metastases (9 adenocarcinomas, 4 poorly differentiated carcinomas, 3 sarcomas, 2 small-cell-lung-cancer, 2 epthelial cell cancer, 1 acute myeloid leukemia). Standard microsurgical removal of the ISCM was performed. Functional outcome was graded according to a standardized scale and factors influencing outcome and survival were statistically analyzed.

Results: Median progression-free survival was 13 weeks and the median overall survival was 31 weeks. In 5 patients (38%) the intramedullary lesion was the initial manifestation of the malignant disease. All poorly differentiated carcinomas and all sarcomas were resected incompletely. Surgical radicality presented a negative predictive factor for functional outcome, increasing the radicality leading to functional deterioration. Age, sex, tumor localization, surgical radicality and the presence of neoplastic meningeosis did not affect survival.

Conclusions: Surgery of ISCM can be performed with an acceptable operative morbidity. Radicality depended on tumor histology. However, radical tumor removal did not affect survival and was correlated with a poor functional outcome. Therefore, complete surgical removal of ISCM should only be intended in patients in whom an unproblematic excision is feasible.