touchONCOLOGY touchONCOLOGY
Read Time: 2 mins

Symptomatic Spinal Metastases from Intracranial High-grade Glioma – Report of Four Cases and Review of the Literature

Copy Link
Published Online: Aug 5th 2008 European Oncology & Haematology, 2011;7(4):213–6 DOI: https://doi.org/10.17925/EOH.2012.08.4.213
Authors: James Powell
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

Intraspinal (leptomeningeal or intramedullary) metastases from primary intracranial gliomas have been well documented in several clinical and pathological series; however, symptomatic intraspinal metastases remain rare. We conducted a retrospective search of cases of intraspinal metastases treated at our centre and report four cases of symptomatic intraspinal leptomeningeal and intramedullary metastases from an intracranial glioma. The mean age of the four cases was 43 years (range 28–55 years). The intraspinal metastases were detected after a median time of 18.5 months after onset of the disease and the median survival time of the four patients from detection of spinal metastases was one month. Median overall survival of the four patients was 19 months. One patient was treated with surgery and all received radiotherapy treatment. Radiotherapy provided good initial palliation of pain but improvement in neurological deficits was limited.Overall, prognosis in cases of leptomeningeal and intramedullary metastases from primary intracranial glioma is very poor; however, this diagnosis should be considered in patients with malignant glioma presenting with new back pain and/or associated spinal neurological signs or symptoms. Radiotherapy provided relief of pain and some improvement in neurological function but no survival advantage. Clinical awareness and recognition of this entity will become increasingly important as local control of primary malignant glioma improves and corresponding improvements in outcome and prognosis of this disease are observed.

Keywords

Intramedullary metastases, leptomeningeal metastases, glioma, radiotherapy

Article:

Intraspinal (leptomeningeal or intramedullary) metastases from primary intracranial gliomas have been well documented in several clinical and pathological series.1–5 Post-mortem and cytological incidence of meningeal and cerebrospinal fluid (CSF) dissemination of up to 40 % has been demonstrated in these studies. Symptomatic intraspinal metastases in patients with primary intracerebral gliomas occur rarely however – roughly 1–5 % in published series6–9 – with the reduced incidence of symptomatic metastases primarily attributed to poor survival in this group of patients.

In this case series, we report four cases of symptomatic intraspinal leptomeningeal and intramedullary metastases from an intracranial glioma. Two cases of primary anaplastic astrocytoma, one case of glioblastoma multiforme (GBM) and one unspecified grade 3 glioma are presented. Three cases are of leptomeningeal metastases only, while one case is of simultaneous leptomenigeal and intramedullary metastases. We report the clinical findings, radiographic evaluation, treatment and subsequent clinical course of these patients.

Case Reports
The mean age of the four cases in our series was 43 years (28–55 years). The intraspinal metastases were detected after a median time of 18.5 months after onset of the disease and the median survival time of the four patients from detection of intraspinal metastases was one month. Median overall survival of the four patients was 19 months.

Case 1
In April 1993, this 28-year-old man presented following a generalised seizure. Computed tomography (CT) head scan demonstrated a large mass in the right temporal lobe with moderate surrounding oedema and compression of the lateral ventricle. Subtotal resection was performed with histopathology demonstrating low-grade astrocytoma and no adjuvant treatment was given. He developed recurrent seizures in 1996 and clinical examination demonstrated bilateral papilloedema; he underwent a further craniotomy and debulking for recurrent high-grade astrocytoma. He proceeded to cranial radiotherapy, 60 Gy in 2 Gy fractions commencing six weeks after surgery given with concurrent procarbazine, lomustine and vincristine (PCV) chemotherapy. Post-radiotherapy CT scan showed residual disease. Chemotherapy was completed in May 1997 and four months later the patient attended his general practitioner (GP) complainingof back pain, progressive leg weakness and numbness in the legs and one week later was admitted to hospital with urinary retention.

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

The author has no conflicts of interest to declare.

Correspondence

James Powell, Specialist Registrar, 53 Westbourne Road, Penarth, Vale of Glamorgan, CF64 3HB, Wales. E: jpowell77@doctors.org.uk

Received

2011-01-31T00:00:00

References

  1. Cairns H, Russell DS, Intracranial and spinal metastases in gliomas of the brain, Brain, 1931;54:377–420.
  2. Brian P, CSF seeding of intra-cranial tumours: a study of 96 cases, Clin Radiol, 1974;25:355–60.
  3. Salazar OM, Rubin P, The spread of glioblastoma multiforme as a determining factor in the radiation treated volume, Int J Radiat Oncol Biol Phys, 1976;1:627–37.
  4. Erlich SS, Davis RL, Spinal subarachnoid metastases from primary intracranial glioblastoma multiforme, Cancer, 1978;42:2854–64.
  5. Awad I, Bay JW, Rogers L, Leptomeningeal metastasis from supratentorial malignant gliomas, Neurosurgery, 1986;19:247–51.
  6. Vertosick FT, Selker RG, Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical series, Neurosurgery, 1990;27:516–21.
  7. Schwaninger M, Patt S, Henningsen P, Schmidt D, Spinal canal metastases: a late complication of glioblastoma, J Neuro Oncol, 12:93–8.
  8. Hubner F, Braun V, Richter HP, Case reports of symptomatic metastases in four patients with primary intracranial gliomas, Acta Neurochir (Wien), 2001;143:25–9.
  9. Stark AM, Nabavi A, Mehdorn HM, Blomer U, Glioblastoma multiforme – report of 267 cases treated at a single institution, Surg Neurol, 2005;63:162–9.
  10. Materlik B, Steidle-Katic U, Wauschkuhn B, et al., Spinal metastases of malignant gliomas, Strahlentherapie Onkol, 1998;174:478–81.
  11. Hamilton MG, Tranmer BI, Hagen NA, Supratentorial glioblastoma with spinal cord intramedullary metastasis, Can J Neurol Sci, 1993;20:65–8.
  12. Alatakis S, Malham GM, Thien C, Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review, Surg Neurol, 2001;56:33–8.
  13. Nakagawa K, Sasaki S, Hatakeyama T, et al., A clinicopathological study of the spinal leptomeningeal dissemination from cerebral malignant gliomas without a recurrence of the primary lesions, Gan No Rinsho, 1990;36:57–65.
  14. Buhl R, Barth H, Hugo H-H, et al., Spinal drop metastases in recurrent glioblastoma multiforme, Acta Neurochir (Wien), 1998;140:1001–5.
  15. Karaca M, Andrieu MN, Hicsonmez A, et al., Cases of glioblastoma metastasizing to spinal cord, Neurol India, 2006;54:428–30.
  16. Scoccianti S, Detti B, Meattini I, et al., Symptomatic leptomeningeal and intramedullary metastases from intracranial glioblastoma multiforme: a case report, Tumori, 2008;94:877–81.
  17. Choucair AK, Levin VA, Gutin PH, et al., Development of multiple lesions during radiation therapy and chemotherapy in patients with gliomas, J Neurosurg, 1986;65:654–8.
  18. Choi PP, Shapera S, What’s your call? Drop metastases, CMAJ, 2006;175:475–7.

Further Resources

Share this Article
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72