Intradural and extradural spinal metastases

Intradural spinal metastases are uncommon. The outcome of surgical treatment of intra- and extramedullary intradural metastases is considered to be poor, with rapid clinical deterioration. The question of optimal treatment remains controversial. We present an overview of the clinical outcome and surgical treatment of 220 spinal metastases carried out in our centre from 1980 to 1999, with particular emphasis on 11 intradural metastases. Clinical history, signs, surgical approach, outcome, and radiological reports were obtained by review of patient charts. Secondary spinal tumours most often originated from carcinomas of the breast, lung, kidney, gastrointestinal tract, and prostate. In 12% of cases, no primary tumour could be found. Drop metastases of intracranial pathology appeared in 3%. Intradural metastases were seen in 11 patients and formed a very heterogeneous group with predominance of melanoma, lymphoma, and medulloblastoma. Functional recovery and survival time were worse in intradural metastases than in extradural metastases, and the patients were younger. Treatment of metastases is designed to relieve pain and preserve or restore neurological function palliatively. Intradural metastases are a devastating condition with usually fatal outcome. Selected patients who undergo aggressive surgical treatment may have substantially increased survival.