INTRAMEDULLARY SPINAL-CORD METASTASIS - REPORT OF 3 CASES AND REVIEW OF THE LITERATURE

BACKGROUND Intramedullary spinal cord metastasis is rare; but it is be ing encountered with increasing frequency. Optimal treatment after dia gnosis remains controversial. METHODS In the last 3 years, we have enc ountered three cases of intramedullary metastasis presenting as focal mass lesions with minimal systemic evidence of cancer. We present our results in these patients and review the literature in an effort to mo re optimally define both the natural course of this disease, as well a s a potential subset of patients who might benefit from more aggressiv e treatment. RESULTS With the availability of more sensitive imaging t echniques, these tumors are being diagnosed with increasing frequency. Magnetic resonance imaging is sensitive, but nonspecific, in distingu ishing intramedullary spinal cord metastases from primary cord tumors. Urgent biopsy is often necessary prior to definitive treatment. Radia tion with chemotherapy significantly prolongs survival. Radical subtot al resection may offer additional quality survival, especially in case s of metastatic melanoma with an occult primary. CONCLUSIONS Regardles s of treatment, many patients survive less than 1 year. Intramedullary spinal cord metastasis is a devastating condition, but with appropria te diagnosis and aggressive treatment, selected patients may have subs tantially increased survival.