79 Views

Surgical Excision of Intradural Metastases from Systemic Cancers: A 10 Year Institutional Experience

Friday, May 3, 2024

Presenting Author(s)

VA

Vardhaan S. Ambati, MS

Medical Student
University of California San Francisco
San Jose, California, United States

Co-Author(s)

Christopher P. Ames, MD

Neurosurgeon
University of California, San Francisco
San Francisco, California, United States
JB

John Bernabei, MD, PhD

Resident Physician
UCSF
San Francisco, California, United States
CC

Cynthia Chin, MD

Professor
UCSF
San Francisco, California, United States
AC

Aaron J. Clark, MD, PhD

Associate Professor
UCSF
San Francisco, California, United States
Nishanth Krishnan, BS

Medical Student
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Arati Patel, MD

Resident Physician
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Irene Say, MD

Assistant Professor
UCSF
Sacramento, California, United States
Michael E. Tawil, BS

Medical Student
University of California San Francisco
San Francisco, CA, US

Introduction: Spinal intradural metastases are rare and are usually managed non-operatively given poor prognosis of widespread metastatic disease. Surgical resection is considered in cases of rapid, progressive neurological decline. We describe our single-center, 10-year experience of surgical resection of spinal intradural metastases.

Methods: Adults who underwent surgical resection of spinal intradural metastatic (excluding neurogenic) tumors at a single quaternary care institution over 10 years were reviewed. Clinical, surgical, and postoperative outcomes were summarized.

Results: Twelve patients (5 female) with mean age 58.3 years (range 32.5 to 77.6) underwent resection of spinal intradural metastases (5 intramedullary, 7 extramedullary). Cases included metastatic adenocarcinoma (2 breast, 1 parotid, 1 uterine), melanoma (3), renal cell carcinoma (2), follicular thyroid carcinoma (1), adenoid cystic carcinoma (1), and prostate cancer (1). Tumors were located at thoracolumbar junction (6), cervicothoracic junction (3), lumbar (2), and cervical spine (1). Patients presented with mean 9.4 weeks (range 1-day to 1-year) of symptoms. At presentation, 9 were found to have leptomeningeal disease, and 6 had brain metastases. All patients underwent laminectomy (median 3; range 2-5 levels). Gross total resection of symptom-causing tumors was achieved in 5 of the 12 patients. Following surgery, 11 patients demonstrated stable/improving neurological exams from preoperative baseline. Ninety-day readmission rate was 50%, and two patients required reoperation for pseudomeningocele. Eleven patients were treated with neoadjuvant/adjuvant therapy (TKIs, hormonal, or immunotherapy), and 6 underwent radiation therapy. Mean follow-up time was 1.2 years, at which point 3 patients died (mean survival 2-years, range 1month-4.9years). Mean cohort Karnofsky Performance Scale improved from 44% preoperatively (range 30-70%) to 53% (64% excluding deceased patients) (range 0% [deceased] to 90%).

Conclusion : This is one of the largest series of surgically treated intradural nonneurogenic metastases. Even in patients with widespread metastatic burden, resection of intradural tumors in patients with neurological decline may improve postoperative function and survival.