Journal of neurosurgery
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Journal of neurosurgery · Aug 1996
ReviewThe surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment.
The authors retrospectively reviewed the surgical outcomes in 10 cases of symptomatic intradural extramedullary spinal metastases of nonneurogenic origin because the collective experience in treating this rare manifestation of systemic cancer is limited. Pain and weakness were the presenting complaints in 70% of the patients and sensory changes were found in all cases. Cytological tests on one specimen of cerebrospinal fluid (CSF) from each of seven patients showed malignant cells in two cases. ⋯ Results of surgical decompression were poor with only 30% of the patients showing improvement, at a 20% risk of perioperative mortality and a 60% risk of morbidity. Plans for surgical intervention in patients with intradural extramedullary metastases from a distant noneurogenic source should be weighed against the high association with intracranial lesions, overall poor prognosis, and modest symptomatic results of decompression. Comprehensive evaluation including multiple specimens of CSF for cytology and contrast-enhanced MR imaging should be undertaken to exclude patients with diffuse leptomeningeal involvement, who should be treated by means other than surgery.