Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 18675 Munich, Germany.
Acta Neurochir (Wien). 2012 Feb;154(2):349-57. doi: 10.1007/s00701-011-1204-1. Epub 2011 Oct 19.
Intradural metastases of nonneurogenic origin represent an extremely rare manifestation of systemic cancer. The respective literature is very scarce.
We retrospectively evaluated nine patients with intradural metastases treated surgically from March 2006 until today at our department.
Four metastases were intramedullary and five intradural extramedullary. Localisation along the spine involved: cervical n = 3, thoracic n = 3, and conus/cauda n = 3. Five patients were female and four male, with a median age of 71 years. Histology showed: breast cancer n = 2, NSCLC (non-small cell lung cancer) n = 2, SCLC (small cell lung cancer) n = 1, colon carcinoma n = 1, malignant skin melanoma n = 1, squamous cell carcinoma of the skin n = 1, and ovarian carcinoma n = 1. Holospinal dissemination in terms of leptomeningeal carcinomatosis according to MRI or positive CSF (cerebrospinal fluid) cytology, respectively, was found in four patients. Gross total resection was achieved in four patients and debulking in five. Results of surgical decompression were: six patients (67%) exhibited immediate improvement of neurological symptoms and/or pain; four of them even improved according to the McCormick Scale score (44%); two patients (22%) were unchanged, and one (11%) exhibited worsening of neurological symptoms after surgery. Median survival time after surgery was 7.3 months.
Intradural metastases are associated with limited survival time. Accordingly, the aim of surgery is strictly palliative. The majority of patients benefit with respect to neurological deficit/pain (67%) independent of the extent of resection. Thus, decompressive surgery is recommended to increase the quality of life.
非神经源性起源的硬脊膜内转移是全身癌症的一种极其罕见的表现。相应的文献非常稀少。
我们回顾性评估了自 2006 年 3 月以来在我科接受手术治疗的 9 例硬脊膜内转移患者。
4 例转移位于髓内，5 例位于硬脊膜外髓内。脊柱局部定位包括：颈段 3 例，胸段 3 例，圆锥/马尾段 3 例。5 例为女性，4 例为男性，中位年龄为 71 岁。组织学显示：乳腺癌 2 例，非小细胞肺癌（NSCLC）2 例，小细胞肺癌（SCLC）1 例，结肠癌 1 例，恶性皮肤黑色素瘤 1 例，皮肤鳞状细胞癌 1 例，卵巢癌 1 例。根据 MRI 或阳性脑脊液（CSF）细胞学检查，分别发现 4 例患者存在脑膜转移。4 例患者行全切除，5 例行部分切除。手术减压的结果为：6 例患者（67%）的神经症状和/或疼痛立即改善；其中 4 例根据 McCormick 分级评分（44%）得到改善；2 例（22%）无变化，1 例（11%）术后神经症状恶化。手术后的中位生存时间为 7.3 个月。
硬脊膜内转移的生存时间有限。因此，手术的目的严格是姑息性的。大多数患者的神经功能缺损/疼痛都有改善（67%），与切除范围无关。因此，建议行减压手术以提高生活质量。
