Perrin R G, Livingston K E, Aarabi B
J Neurosurg. 1982 Jun;56(6):835-7. doi: 10.3171/jns.1982.56.6.0835.
The management of 10 patients with symptomatic localized intradural extramedullary spinal metastasis is reviewed. The single most common primary source was carcinoma of the breast (four cases). The initial symptom in nine patients was pain, with five patients reporting a characteristically severe cramping discomfort with radicular distribution. All patients underwent laminectomy decompression. At the time of surgery, six of the patients were weak but ambulatory and four were bedridden. Following surgery, four patients enjoyed some measure of pain relief, seven patients became ambulatory, and three remained bedridden. Two patients achieved a "satisfactory" result, and were walking and continent 6 months after surgery. Secondary brain tumors were demonstrated or implicated in nine patients, supporting the concept that the spinal metastases represented tertiary deposits following dissemination via the cerebrospinal fluid. Symptomatic intradural extramedullary spinal metastasis causes a virulent clinical syndrome with poor prognosis and disappointing outcome after treatment. Given the high incidence of associated cerebral metastatic involvement, total neuraxis radiation and/or chemotherapy should be considered when symptomatic spinal metastasis is discovered to be intradural and extramedullary.
回顾了10例有症状的局限性硬脊膜内髓外脊柱转移瘤患者的治疗情况。最常见的单一原发灶是乳腺癌（4例）。9例患者的初始症状为疼痛，其中5例报告有特征性的严重痉挛性不适并呈神经根分布。所有患者均接受了椎板切除术减压。手术时，6例患者虚弱但可走动，4例卧床不起。手术后，4例患者的疼痛得到一定程度缓解，7例患者能够走动，3例仍卧床不起。2例患者取得了“满意”结果，术后6个月能行走且大小便失禁。9例患者发现有继发性脑肿瘤或与之相关，这支持了脊柱转移瘤是经脑脊液播散后的三期转移灶这一概念。有症状的硬脊膜内髓外脊柱转移瘤会导致严重的临床综合征，预后不良，治疗后效果令人失望。鉴于相关脑转移受累的发生率较高，当发现有症状的脊柱转移瘤为硬脊膜内髓外时，应考虑全神经轴放疗和/或化疗。
