SPCM-04 SURGICAL EXCISION OF SPINAL INTRADURAL METASTASES: A 10 YEAR INSTITUTIONAL EXPERIENCE

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.

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.

Twelve patients (5 female) with mean age 58.3 (range 32.5-77.6) years 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; 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 12 patients. Postoperatively, 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, immunotherapy). Six underwent radiation therapy. Mean follow-up was 1.2 years, at which point, 3 patients died (mean survival 2-years, range 1month-4.9years). Mean cohort Karnofsky Performance Scale (KPS) improved from 44% preoperatively (range 30-70%) to 53% (range 0% [deceased]-90%); mean KPS improves to 64% if deceased patients are excluded.

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