Meltem Ivren, Dilber Yalman, Basem Ishak, Sebastian Ille, Sandro M Krieg, Pavlina Lenga
{"title":"Beyond surgical radicality in intramedullary spinal cord metastases: neurological function and systemic disease burden drive patient outcomes.","authors":"Meltem Ivren, Dilber Yalman, Basem Ishak, Sebastian Ille, Sandro M Krieg, Pavlina Lenga","doi":"10.1007/s11060-025-05119-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Intramedullary spinal cord metastases (ISCM) are rare, clinically challenging lesions with limited evidence-based guidance. Optimal surgical management remains controversial, particularly regarding the ideal extent of resection (EOR) and associated prognostic factors. This study systematically evaluates perioperative outcomes, neurological function, and short-term survival according to biopsy-only, subtotal, or gross total resection (GTR) approaches.</p><p><strong>Methods: </strong>This retrospective single-center study included 16 patients treated surgically for histologically confirmed ISCM between 2015 and 2024. Patients were stratified by surgical extent (biopsy, subtotal, or total resection). Outcomes included perioperative complications, neurological function, and 90-day survival. A literature review of surgical ISCM series (≥ 5 cases) was also performed.</p><p><strong>Results: </strong>Sixteen patients with a median age of 59 years (56% male) were included. Thoracic lesions predominated (56%). Surgical complications were seen in 19% of the cases, however no irreversible neurological injury and no intraoperative mortality or transfusion occured. Early mortality was lowest following GTR (13%) compared to subtotal (60%) or biopsy-only (33%) approaches (p = 0.015). However, multivariable regression showed that EOR alone was not independently predictive of short-term survival (p = 0.834), indicating patient selection bias. Neurological function remained stable or improved in all of cases, irrespective of resection extent.</p><p><strong>Conclusion: </strong>Surgical management of ISCM can be performed safely with minimal neurological morbidity, achieving symptom stabilization or improvement. Although GTR was associated with favorable short-term survival, systemic disease burden and postoperative neurological function are stronger prognostic factors. Therefore, surgical decisions should prioritize functional preservation and patient selection based on disease extent and overall health.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11060-025-05119-5","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Intramedullary spinal cord metastases (ISCM) are rare, clinically challenging lesions with limited evidence-based guidance. Optimal surgical management remains controversial, particularly regarding the ideal extent of resection (EOR) and associated prognostic factors. This study systematically evaluates perioperative outcomes, neurological function, and short-term survival according to biopsy-only, subtotal, or gross total resection (GTR) approaches.
Methods: This retrospective single-center study included 16 patients treated surgically for histologically confirmed ISCM between 2015 and 2024. Patients were stratified by surgical extent (biopsy, subtotal, or total resection). Outcomes included perioperative complications, neurological function, and 90-day survival. A literature review of surgical ISCM series (≥ 5 cases) was also performed.
Results: Sixteen patients with a median age of 59 years (56% male) were included. Thoracic lesions predominated (56%). Surgical complications were seen in 19% of the cases, however no irreversible neurological injury and no intraoperative mortality or transfusion occured. Early mortality was lowest following GTR (13%) compared to subtotal (60%) or biopsy-only (33%) approaches (p = 0.015). However, multivariable regression showed that EOR alone was not independently predictive of short-term survival (p = 0.834), indicating patient selection bias. Neurological function remained stable or improved in all of cases, irrespective of resection extent.
Conclusion: Surgical management of ISCM can be performed safely with minimal neurological morbidity, achieving symptom stabilization or improvement. Although GTR was associated with favorable short-term survival, systemic disease burden and postoperative neurological function are stronger prognostic factors. Therefore, surgical decisions should prioritize functional preservation and patient selection based on disease extent and overall health.
期刊介绍：
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
