Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar.
Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar.
World Neurosurg. 2020 Nov;143:480-489. doi: 10.1016/j.wneu.2020.07.163. Epub 2020 Jul 31.
Spinal metastasis of cerebral glioblastoma (GBM) is rare, with some reports suggesting a prevalence of 1%-2%.
Herein, we present 2 unique cases of spinal metastasis of cerebral GBM, 1 of which was histologically proven to be a drop spinal GBM metastasis. The first case was a 25-year-old female who presented with a spinal intradural intramedullary spinal lesion a few months after resection of a left temporal lobe GBM (isocitrate dehydrogenase wild type). The patient underwent surgical resection of the new lesion, and subsequent histopathologic examination proved that the intramedullary spinal lesion was GBM. The patient experienced full recovery postoperatively, and then a few months later, she presented again with widespread drop metastasis of the spinal cord. The second case is a middle-aged male with right temporal GBM who developed spinal metastasis 10 months after his diagnosis.
We are reporting these 2 cases due to the rarity of spinal metastasis in GBM. We reviewed the current literature and included genetic and molecular profiles in the discussion. Currently, there are no established treatment guidelines for GBM spinal metastasis. The Stupp protocol after initial brain surgery for GBM did not appear to have beneficial effects on prolonging survival in these patients with spinal metastasis. The goal of treatment was primarily to alleviate pain and neurologic deficits with no effect on overall outcome. Prognosis following the diagnosis of spinal metastasis is poor.
脑胶质母细胞瘤(GBM)的脊柱转移较为罕见,一些报道显示其发生率为 1%-2%。
本文报告了 2 例脑 GBM 脊柱转移的特殊病例,其中 1 例经组织学证实为脊髓 GBM 转移。第 1 例患者为 25 岁女性,左颞叶 GBM(异柠檬酸脱氢酶野生型)切除后数月出现脊髓髓内硬膜内脊髓病变。患者接受了新病变的手术切除,随后的组织病理学检查证实髓内脊髓病变为 GBM。患者术后完全康复,几个月后再次出现广泛的脊髓滴转移。第 2 例是一名中年男性,右侧颞叶 GBM,确诊后 10 个月出现脊柱转移。
我们报告这 2 例病例是因为 GBM 脊柱转移较为罕见。我们回顾了目前的文献,并在讨论中纳入了遗传和分子特征。目前,GBM 脊柱转移尚无既定的治疗指南。GBM 初始脑部手术后采用 Stupp 方案似乎对这些有脊柱转移的患者的生存延长没有有益效果。治疗的主要目的是缓解疼痛和神经功能缺损,对总体预后没有影响。诊断为脊柱转移后预后较差。