Intradural tumor recurrence after resection of extradural metastasis: a rare but potential complication of intraoperative durotomy

J Neurosurg Spine. 2014 Jun;20(6):734-9. doi: 10.3171/2014.3.SPINE13896. Epub 2014 Apr 11.

Abstract

Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.

Keywords: EBRT = external-beam radiotherapy; intradural; metastasis; oncology; recurrence; spinal; tumor.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Signet Ring Cell / complications*
  • Carcinoma, Signet Ring Cell / secondary*
  • Carcinoma, Signet Ring Cell / therapy*
  • Colorectal Neoplasms / pathology*
  • Combined Modality Therapy
  • Decompression, Surgical
  • Disease Progression
  • Dura Mater / pathology*
  • Fluorouracil / therapeutic use
  • Humans
  • Laminectomy
  • Leucovorin / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Organoplatinum Compounds / therapeutic use
  • Pain, Intractable / etiology
  • Pain, Intractable / therapy
  • Radiosurgery
  • Spinal Cord Compression / etiology*
  • Spinal Cord Compression / surgery*
  • Spinal Neoplasms / complications*
  • Spinal Neoplasms / secondary*
  • Spinal Neoplasms / therapy*

Substances

  • Organoplatinum Compounds
  • Leucovorin
  • Fluorouracil

Supplementary concepts

  • Folfox protocol