Clinical Features and Neurosurgical Management of Metastatic Intradural Extramedullary Renal Cell Carcinoma

Intradural extramedullary metastasis of renal cell carcinoma is exceedingly uncommon, and only 19 cases have been reported in the literature. It is thought to metastasize from the kidneys through venous networks or along nerves and may also spread from brain metastases through cerebrospinal fluid. We present a 52-year-old female, two years after a nephrectomy with myelopathic symptoms, who was found to have thoracic intradural extramedullary metastasis from renal cell carcinoma. The thoracic tumor was resected without any added deficit, but an additional brain mass was found on postoperative imaging. The present case and a literature review were discussed to explore considerations for neurosurgical intervention in similar patients, evaluate surgical outcomes, and highlight current theories on routes of metastasis. Given the risk of neurological decline in patients with metastatic intradural renal cell carcinoma, surgical resection should be considered upon its discovery, and postoperative surveillance imaging is encouraged.