Intramedullary Spinal Cord Metastases: A 20-Year Institutional Experience with a Comprehensive Literature Review

Objectives To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. Methods We undertook a 20-year (1989-2009) retrospective study of a series of eight...

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Veröffentlicht in:World neurosurgery 2013-03, Vol.79 (3), p.576-584
Hauptverfasser: Sung, Wen-Shan, Sung, Mei-Jo, Chan, Jon Ho, Manion, Benjamin, Song, Jeeuk, Dubey, Arvind, Erasmus, Albert, Hunn, Andrew
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container_end_page 584
container_issue 3
container_start_page 576
container_title World neurosurgery
container_volume 79
creator Sung, Wen-Shan
Sung, Mei-Jo
Chan, Jon Ho
Manion, Benjamin
Song, Jeeuk
Dubey, Arvind
Erasmus, Albert
Hunn, Andrew
description Objectives To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. Methods We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. Results Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. Conclusion ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.
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Methods We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. Results Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. Conclusion ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2012.04.005</identifier><identifier>PMID: 22484768</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms - pathology ; Child ; Child, Preschool ; Female ; Humans ; Intramedullary ; Lung Neoplasms - pathology ; Male ; Metastases ; Middle Aged ; Muscle Weakness - etiology ; Nervous System Diseases - etiology ; Neurosurgery ; Pain - etiology ; Prognosis ; Quality of Life ; Retrospective Studies ; Spinal cord ; Spinal Cord Neoplasms - epidemiology ; Spinal Cord Neoplasms - secondary ; Spinal Cord Neoplasms - surgery ; Survival ; Survival Analysis ; Treatment Outcome ; Young Adult</subject><ispartof>World neurosurgery, 2013-03, Vol.79 (3), p.576-584</ispartof><rights>2013</rights><rights>Crown Copyright © 2013. 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Methods We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. Results Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. Conclusion ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast Neoplasms - pathology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Humans</subject><subject>Intramedullary</subject><subject>Lung Neoplasms - pathology</subject><subject>Male</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Muscle Weakness - etiology</subject><subject>Nervous System Diseases - etiology</subject><subject>Neurosurgery</subject><subject>Pain - etiology</subject><subject>Prognosis</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Spinal cord</subject><subject>Spinal Cord Neoplasms - epidemiology</subject><subject>Spinal Cord Neoplasms - secondary</subject><subject>Spinal Cord Neoplasms - surgery</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1O3DAUhS3UqiDgBbpAXnaT4L-MnapCQiMoIw2qBHTRleWxb4SnmSTYDgNvX4cBFix6Zel6cc6RzncR-kpJSQmdna7LbQdjyQhlJRElIdUeOqBKqkLJWf3p_V-RfXQc45rk4VQoyb-gfcaEEnKmDtCw6FIwG3Bj25rwjG8H35kWz_vg8DUkE_OD-B2fY0aKP2ACXnQx-TQm30_Ci6cBgofOAt76dI9Ntm6GAPfQRf8IeOkTBJPGAPgGHj1sj9DnxrQRjl_3Ifp9eXE3vyqWv34u5ufLwgpKUyGEqRSxgiuhHFWGrwiolZSCssY5Ll3l6qYmrLaG80Y0glMD0kkOK9o4PuOH6Nsudwj9wwgx6Y2PFnLLDvoxasqZqkQla5WlbCe1oY8xQKOH4DeZhqZET7D1Wk-w9QRbE6Ez7Gw6ec0fVxnfu-UNbRb82Akgt8zNg472BZTzAWzSrvf_zz_7YLet77w17V94hrjux5D55x46Zo--nc49XZsyQkSlKv4PdzGmCA</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Sung, Wen-Shan</creator><creator>Sung, Mei-Jo</creator><creator>Chan, Jon Ho</creator><creator>Manion, Benjamin</creator><creator>Song, Jeeuk</creator><creator>Dubey, Arvind</creator><creator>Erasmus, Albert</creator><creator>Hunn, Andrew</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Intramedullary Spinal Cord Metastases: A 20-Year Institutional Experience with a Comprehensive Literature Review</title><author>Sung, Wen-Shan ; Sung, Mei-Jo ; Chan, Jon Ho ; Manion, Benjamin ; Song, Jeeuk ; Dubey, Arvind ; Erasmus, Albert ; Hunn, Andrew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-44a580c43848d18a3b0e8b77412fdd37d5d9f9029ca33f4f431ae7d73eb1fd363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast Neoplasms - pathology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Humans</topic><topic>Intramedullary</topic><topic>Lung Neoplasms - pathology</topic><topic>Male</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Muscle Weakness - etiology</topic><topic>Nervous System Diseases - etiology</topic><topic>Neurosurgery</topic><topic>Pain - etiology</topic><topic>Prognosis</topic><topic>Quality of Life</topic><topic>Retrospective Studies</topic><topic>Spinal cord</topic><topic>Spinal Cord Neoplasms - epidemiology</topic><topic>Spinal Cord Neoplasms - secondary</topic><topic>Spinal Cord Neoplasms - surgery</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sung, Wen-Shan</creatorcontrib><creatorcontrib>Sung, Mei-Jo</creatorcontrib><creatorcontrib>Chan, Jon Ho</creatorcontrib><creatorcontrib>Manion, Benjamin</creatorcontrib><creatorcontrib>Song, Jeeuk</creatorcontrib><creatorcontrib>Dubey, Arvind</creatorcontrib><creatorcontrib>Erasmus, Albert</creatorcontrib><creatorcontrib>Hunn, Andrew</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sung, Wen-Shan</au><au>Sung, Mei-Jo</au><au>Chan, Jon Ho</au><au>Manion, Benjamin</au><au>Song, Jeeuk</au><au>Dubey, Arvind</au><au>Erasmus, Albert</au><au>Hunn, Andrew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intramedullary Spinal Cord Metastases: A 20-Year Institutional Experience with a Comprehensive Literature Review</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>79</volume><issue>3</issue><spage>576</spage><epage>584</epage><pages>576-584</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>Objectives To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. Methods We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. Results Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. Conclusion ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22484768</pmid><doi>10.1016/j.wneu.2012.04.005</doi><tpages>9</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Breast Neoplasms - pathology
Child
Child, Preschool
Female
Humans
Intramedullary
Lung Neoplasms - pathology
Male
Metastases
Middle Aged
Muscle Weakness - etiology
Nervous System Diseases - etiology
Neurosurgery
Pain - etiology
Prognosis
Quality of Life
Retrospective Studies
Spinal cord
Spinal Cord Neoplasms - epidemiology
Spinal Cord Neoplasms - secondary
Spinal Cord Neoplasms - surgery
Survival
Survival Analysis
Treatment Outcome
Young Adult
title Intramedullary Spinal Cord Metastases: A 20-Year Institutional Experience with a Comprehensive Literature Review
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