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Beyond surgical radicality in intramedullary spinal cord metastases: neurological function and systemic disease burden drive patient outcomes

  • 0Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Journal of Neuro-Oncology +

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June 30, 2025

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June 30, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Surgical management of intramedullary spinal cord metastases (ISCM) is safe, preserving neurological function. While gross total resection showed lower early mortality, patient selection and systemic disease burden are key prognostic factors.

Area Of Science

  • Neurosurgery
  • Oncology
  • Spinal Surgery

Background

  • Intramedullary spinal cord metastases (ISCM) are rare and challenging lesions.
  • Optimal surgical management, including extent of resection (EOR), remains controversial.
  • Limited evidence-based guidance exists for ISCM treatment.

Purpose Of The Study

  • To evaluate perioperative outcomes, neurological function, and short-term survival in surgically treated ISCM patients.
  • To compare outcomes based on different surgical extents: biopsy-only, subtotal resection, and gross total resection (GTR).
  • To identify prognostic factors influencing survival and neurological recovery in ISCM.

Main Methods

  • Retrospective single-center study of 16 patients surgically treated for ISCM (2015-2024).
  • Patients stratified by surgical extent (biopsy, subtotal, or total resection).
  • Outcomes assessed included perioperative complications, neurological function, and 90-day survival; a literature review was also performed.

Main Results

  • Sixteen patients (median age 59, 56% male) with predominantly thoracic ISCM were included.
  • Surgical complications occurred in 19% with no irreversible neurological injury or intraoperative mortality.
  • Gross total resection (GTR) showed the lowest early mortality (13%) compared to subtotal (60%) or biopsy-only (33%) (p=0.015), but EOR was not an independent predictor of survival (p=0.834).
  • Neurological function remained stable or improved in all patients regardless of resection extent.

Conclusions

  • Surgical management of ISCM is safe, with minimal neurological morbidity and potential for symptom stabilization or improvement.
  • While GTR correlated with better short-term survival, systemic disease burden and postoperative neurological status are more significant prognostic indicators.
  • Surgical decisions should prioritize functional preservation and careful patient selection based on overall health and disease extent.

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