An overview of intramedullary spinal cord metastases accompanied by a 2D intraoperative video
Nehemiah Stewart1,2, Brandon Lee1, George Bourdages3
1Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
Background:
Metastatic intramedullary spinal cord metastases (IMSCMs) constitute <2% of spinal cord tumors. IMSCM is a late-stage manifestation of cancer with a highly variable presentation and poor survival rate. Here, we present an operative video involving gross total resection of an IMSCM (i.e., non-small-cell lung cancer [NSCLC]) in a 74-year-old male.
Case Description:
A functionally independent 74-year-old male with a history of renal cell carcinoma (i.e., prior nephrectomy) and NSCLC presented with progressive right-sided hemiparesis/hemisensory loss. The patient's magnetic resonance imaging showed a right-eccentric metastatic lesion extending from the inferior of C3 to the superior of C5. The patient underwent a laminectomy with C2-C6 instrumentation for focal en bloc resection of the tumor (i.e., pathologically proven to be NSCLC). During surgery, dorsal column mapping defined the electrophysiological midline before proceeding with the midline myelotomy. Five months postoperatively, the patient's right-sided motor function continued to improve, and he was able to continue adjunctive therapies for his NSCLC.
Conclusion:
This study documents the efficacy/utility of gross total en bloc resection in preserving/improving the neurological function of IMSCM lesions in elderly patients.
Insights
Gross total resection of spinal cord tumors in elderly patients can preserve or improve neurological function. This case highlights successful treatment for non-small-cell lung cancer metastasis.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Cord Surgery
Background:
- Intramedullary spinal cord metastases (IMSCMs) are rare, representing <2% of spinal tumors.
- IMSCMs indicate late-stage cancer with poor prognosis and varied presentation.
- Surgical resection is a key treatment modality for managing these lesions.
Observation:
- A 74-year-old male with a history of non-small-cell lung cancer (NSCLC) and renal cell carcinoma presented with progressive hemiparesis.
- MRI revealed a C3-C5 intramedullary metastatic lesion.
- The patient underwent a C2-C6 laminectomy with en bloc resection of the NSCLC metastasis.
Findings:
- Dorsal column mapping was utilized to identify the electrophysiological midline.
- Gross total resection of the intramedullary metastasis was achieved.
- Postoperatively, the patient demonstrated improved motor function and continued cancer therapy.
Implications:
- Gross total en bloc resection is effective in preserving/improving neurological function in elderly patients with IMSCMs.
- This surgical approach offers a viable option for managing late-stage cancer with spinal cord involvement.
- The case underscores the importance of multidisciplinary care in optimizing outcomes for cancer patients with metastatic disease.
