An overview of intramedullary spinal cord metastases accompanied by a 2D intraoperative video.

Abstract

Background: Metastatic intramedullary spinal cord metastases (IMSCMs) constitute <2% of spinal cord tumors. IMSCM is a late-stage manifestation of cancer with a highly variable presentation and poor survival rate. Here, we present an operative video involving gross total resection of an IMSCM (i.e., non-small-cell lung cancer [NSCLC]) in a 74-year-old male.

Case description: A functionally independent 74-year-old male with a history of renal cell carcinoma (i.e., prior nephrectomy) and NSCLC presented with progressive right-sided hemiparesis/hemisensory loss. The patient's magnetic resonance imaging showed a right-eccentric metastatic lesion extending from the inferior of C3 to the superior of C5. The patient underwent a laminectomy with C2-C6 instrumentation for focal en bloc resection of the tumor (i.e., pathologically proven to be NSCLC). During surgery, dorsal column mapping defined the electrophysiological midline before proceeding with the midline myelotomy. Five months postoperatively, the patient's right-sided motor function continued to improve, and he was able to continue adjunctive therapies for his NSCLC.

Conclusion: This study documents the efficacy/utility of gross total en bloc resection in preserving/improving the neurological function of IMSCM lesions in elderly patients.