1
|
Wang C, Rooney MK, Alvarez-Breckenridge C, Beckham TH, Chung C, De BS, Ghia AJ, Grosshans D, Majd NK, McAleer MF, McGovern SL, North RY, Paulino AC, Perni S, Reddy JP, Rhines LD, Swanson TA, Tatsui CE, Tom MC, Yeboa DN, Li J. Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era-A Population-Based Observational Study. Cancers (Basel) 2024; 16:2013. [PMID: 38893133 PMCID: PMC11171081 DOI: 10.3390/cancers16112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio (HR) = 1.09, p < 0.001) and receipt of surgery (HR = 0.43, p = 0.007) were associated with improved survival. Surprisingly, male sex was associated with worse survival (HR = 1.86, p = 0.008) and a younger age at diagnosis compared to females. (4) Conclusions: This study, the largest of its kind, underscores the importance of surgical resection in managing spinal MPE. The unexpected association between male sex and worse survival warrants further investigation into potential sex-specific pathophysiological factors influencing prognosis. Despite limitations, our findings contribute valuable insights for guiding clinical management strategies for spinal MPE.
Collapse
Affiliation(s)
- Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Michael K. Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | | | - Thomas H. Beckham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Brian S. De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Amol J. Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Nazanin K. Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mary F. McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Susan L. McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Robert Y. North
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Subha Perni
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Laurence D. Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Todd A. Swanson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Claudio E. Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Martin C. Tom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Debra N. Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| |
Collapse
|
2
|
Multifocal lumbar myxopapillary ependymoma presenting with drop metastasis: a case report and review of the literature. Spinal Cord Ser Cases 2022; 8:43. [PMID: 35459220 PMCID: PMC9033832 DOI: 10.1038/s41394-022-00513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Spinal myxopapillary ependymomas (SME) are rare WHO grade II neoplasms of the spinal cord. Despite their good prognosis, they have a high propensity for metastasis and recurrence, although the presentation of SME as multifocal is uncommon. CASE PRESENTATION Here we describe a rare case of a 34-year-old man who presented with painful bilateral radiculopathy with sexual dysfunction and altered sensation with defecation. The patient also reported worsening weakness of bilateral lower extremities when climbing stairs. Biopsy results revealed multifocal SME in the lumbar and sacral spine that was treated with staged surgical resection and post-operative focal radiation therapy. DISCUSSION We discuss and evaluate surgical resection and the role of postoperative radiotherapy for SME. We also review the literature surrounding multifocal SME presenting in adults.
Collapse
|
3
|
Dauleac C, Manet R, Meyronet D, Jacquesson T, Berhouma M, Robinson P, Berthiller J, Jouanneau E, Barrey CY, Mertens P. Prognostic factors for progression-free survival of the filum terminale ependymomas in adults. Neurochirurgie 2022; 68:273-279. [PMID: 34998798 DOI: 10.1016/j.neuchi.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To define the prognostic factors for progression and to determine the impact of the histological grading (according to the World Health Organization) on the progression-free survival (PFS) of filum terminale ependymomas. METHODS A retrospective chart review of 38 patients with ependymoma of the filum terminale was performed, focusing on demographic data, preoperative symptoms, tumor size, quality of resection, presence of a tumor capsule, and histological grade. RESULTS Gross total resection (GTR) was achieved in 30 patients (78.9%). Histopathological analysis found 21 (55.3%) myxopapillary grade I ependymoma (MPE), 16 (42.1%) ependymoma grade II (EGII), and 1 (2.6%) ependymoma grade III. There was no significant difference between the mean ± SD volume of MPE (5840.5 ± 5244.2 mm3) and the one of EGII (7220.3 ± 6305.9 mm3, p=0.5). The mean ± SD follow-up was 54.1 ± 38.4 months. At last follow-up, 30 (78.9%) patients were free of progression. In multivariate analysis, subtotal resection (p=0.015) and infiltrative tumor (p=0.03) were significantly associated with progression. The PFS was significantly higher in patients with encapsulated tumor than in patients with infiltrative tumor (log-rank p=0.01) and in patients who had a GTR in comparison with those who had an incomplete resection (log-rank p=0.05). There was no difference in PFS between patient with MPE and EGII (p=0.1). CONCLUSION The progression of ependymoma of the filum terminale highly depends on the quality of resection, and whether the tumor is encapsulated. Except for anaplastic grade, histopathological type does not influence progression.
Collapse
Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France.
| | - Romain Manet
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France
| | - David Meyronet
- Université de Lyon I, Université de Lyon, Lyon, France; Service d'Anatomo-pathologie, Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Moncef Berhouma
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Philip Robinson
- Unité d'Appui Méthodologique, Département de la Recherche Clinique et Innovation, Hospices Civils de Lyon, Lyon, France
| | - Julien Berthiller
- Unité d'Appui Méthodologique, EPICIME, Cellule Innovation DRCI, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Cédric Y Barrey
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Patrick Mertens
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| |
Collapse
|
4
|
Abdu AM, Alshoabi SA, Alshoaibi AM, Hamid AM, Jhaveri MD. Myxopapillary ependymoma with interval postoperative CSF seeding: A report of an unusual case. Radiol Case Rep 2021; 16:3838-3843. [PMID: 34691347 PMCID: PMC8517289 DOI: 10.1016/j.radcr.2021.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 01/12/2023] Open
Abstract
Myxopapillary ependymoma (MPE) is a unique slow-growing benign (WHO grade 1) subtype of spinal cord ependymoma arising predominantly in the filum terminale. Despite its benign nature, it occasionally disseminates through the cerebrospinal fluid and metastasizes to distant sites. Here, we report an extremely rare case of MPE with interval CSF seeding and metachronous metastasis in a 47 -year-old female presented as a gradually increasing low back pain for three months with bilateral radiculopathy down to the knees. Magnetic resonance imaging (MRI) showed an intradural extramedullary spinal mass of iso-intense signal to the cord on T1 weighted-images (WIs), heterogeneous, predominantly hyperintense signal on T2WIs with homogenous enhancement after contrast administration. L2 laminectomy with gross total resection (GTR) was performed, and histopathological results confirmed the diagnosis of MPE. Adjuvant radiotherapy was administered, followed by series of MRI scans. 28 months after GTR, Lumbar MRI showed multiple tiny enhancing nodules in the cauda equina. 44 months follow-up whole spine MRI revealed multiple intradural extramedullary nodules throughout the entire spine. The largest one measures about 1.5cm opposite to T3 -T4 intervertebral disc space. The patient underwent T3 and T4 laminectomy and GTR under general anesthesia using microsurgical techniques, and the histopathological result came with the diagnosis of MPE.
Collapse
Key Words
- CNS, central nervous system
- CSF, cerebrospinal fluid°C degree centigrade
- GTR, gross total resection
- L2, second lumbar vertebra
- MPE, myxopapillary ependymoma
- MRI, magnetic resonance imaging
- Myxopapillary ependymoma. Interval CSF seeding
- SI, signal intensity
- T3, third thoracic vertebra
- T4, fourth thoracic vertebra
- WHO, world Health Organization
- WIs, weighted images
- kg, kilogram
Collapse
Affiliation(s)
- Ali M Abdu
- Radiology Unit, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sultan A Alshoabi
- College of Applied Medical Sciences, Taibah University, Almadinah, Kingdom of Saudi Arabia
| | - Abdulbaset M Alshoaibi
- Radiology Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Miral D Jhaveri
- Radiology Department, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
5
|
Freiburg Neuropathology Case Conference : A Hearing-Impaired Patient Presenting with Lower Limb Ataxia and Progressive Personality Changes. Clin Neuroradiol 2021; 30:413-418. [PMID: 32451609 PMCID: PMC7326865 DOI: 10.1007/s00062-020-00912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
6
|
Omerhodžić I, Pojskić M, Rotim K, Splavski B, Rasulić L, Arnautovic KI. MYXOPAPILLARY EPENDYMOMA OF THE SPINAL CORD IN ADULTS: A REPORT OF PERSONAL SERIES AND REVIEW OF LITERATURE. Acta Clin Croat 2020; 59:329-337. [PMID: 33456121 PMCID: PMC7808218 DOI: 10.20471/acc.2020.59.02.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Myxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.
Collapse
Affiliation(s)
| | - Mirza Pojskić
- 1Department of Neurosurgery, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina; 2Department of Neurosurgery, University of Marburg, Marburg, Germany; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 7Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 8Semmes Murphey Neurologic & Spine Institute, Memphis, TN, United States; 9Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Krešimir Rotim
- 1Department of Neurosurgery, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina; 2Department of Neurosurgery, University of Marburg, Marburg, Germany; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 7Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 8Semmes Murphey Neurologic & Spine Institute, Memphis, TN, United States; 9Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bruno Splavski
- 1Department of Neurosurgery, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina; 2Department of Neurosurgery, University of Marburg, Marburg, Germany; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 7Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 8Semmes Murphey Neurologic & Spine Institute, Memphis, TN, United States; 9Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lukas Rasulić
- 1Department of Neurosurgery, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina; 2Department of Neurosurgery, University of Marburg, Marburg, Germany; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 7Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 8Semmes Murphey Neurologic & Spine Institute, Memphis, TN, United States; 9Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kenan I Arnautovic
- 1Department of Neurosurgery, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina; 2Department of Neurosurgery, University of Marburg, Marburg, Germany; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 7Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 8Semmes Murphey Neurologic & Spine Institute, Memphis, TN, United States; 9Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| |
Collapse
|
7
|
Spinal Myxopapillary Ependymoma: The Sapienza University Experience and Comprehensive Literature Review Concerning the Clinical Course of 1602 Patients. World Neurosurg 2019; 129:245-253. [PMID: 31152881 DOI: 10.1016/j.wneu.2019.05.206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Spinal myxopapillary ependymoma (sMPE) is an uncommon primary spinal neoplasm infiltrating the spinal cord, conus medullaris (CM), and nerve roots. It is associated with low resection and high recurrence rates. The purpose of this literature review is to evaluate the exact impact of the involvement of the CM and the role played by gross total resection (GTR) on overall survival (OS). METHODS The English literature was systematically investigated using MEDLINE, the NIH Library, PubMed, and Google Scholar search engines with relevant queries. Case series reporting details concerning OS, GTR, and CM involvement rate were included, with a differential statistical weight given by the number of patients enrolled. A final cohort of 1602 clinical records was analyzed according to the 3 selected end point variables. RESULTS The average age was 36.44 ± 3.41 years, and the CM was involved in 28.4% ± 28.2% of cases. The average GTR rate was 53.94% ± 22.20%. Five- and 10-year OS rates were respectively available in 1170 and 1167 cases, with an average 5- and 10-year OS rate of 94.99% ± 3.87% and 92.31% ± 5.73%. By means of analyses performed both on aggregated and disaggregated data a strong positive statistical connection between GTR and increased OS was demonstrated despite the real clinical advantage could range as low as around 1% of increased OS rate. CONCLUSIONS Given the indolent sMPE behavior, it is difficult to evaluate the exact impact of GTR and CM involvement on OS; however, GTR could be associated with a limited survival advantage, whereas CM involvement could be associated with a survival disadvantage.
Collapse
|
8
|
Fonseca L, Cicuendez M, Martínez-Ricarte F, Martínez-Saez E, Cordero E, Bescos A. A rare case of an intramedullary metastasis of a myxopapillary ependymoma. Surg Neurol Int 2019; 10:83. [PMID: 31528421 PMCID: PMC6744754 DOI: 10.25259/sni-96-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Myxopapillary ependimoma (MPE) is a benign slow-growing tumor, and it has been designated histologically as a Grade I neoplasm according to the 2016 World Health Organization classification. Despite the benign character, dissemination and metastasis have occasionally been reported. The retrograde dissemination to other levels of the neuraxis is extremely rare, being more frequent to the intracranial compartment. Case Description: We hereby present a case of medullary metastasis of cauda equina MPE, with a history of having undergone a subtotal resection and postoperative adjuvant radiotherapy. The patient presents complaints of night dorsal pain attributable to intradural metastasis twenty-one years after the first surgical intervention. Conclusion: The case reported highlights the importance of long follow-up in patients with MPE, since the possibility of secondary seeding to distant craniospinal sites or local spinal sites after surgery, and radiotherapy should be considered in metastatic disease.
Collapse
Affiliation(s)
- Lino Fonseca
- Department of Neurosurgery, Centro Hospitalar Lisboa Central-Hospital São José, Serrano, Lisboa, Portugal, Barcelona, Spain
| | - Marta Cicuendez
- Department of Neurosurgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Elena Martínez-Saez
- Department of Pathology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Esteban Cordero
- Department of Neurosurgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Agustín Bescos
- Department of Neurosurgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|