Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease

A review

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Glioblastoma multiforme (GBM) is one of the most common and aggressive primary brain tumors, composing 12%–20% of all intracranial tumors in adults. Average life expectancy is merely 12–14 months following initial diagnosis. Patients with this neoplasm have one of the worst 5-year survival rates among all cancers despite aggressive multimodal treatment consisting of maximal tumor resection, radiation therapy, and adjuvant chemotherapy. With recent advancements in management strategies, there has been improvement in the overall trend in patient outcomes; however, recurrence remains nearly inevitable. While most tumors recur locally, metastases to distal locations have become more common. Specifically, the last decade has seen an increased incidence of spinal metastases, representing an emerging complication in patients with intracranial GBM. However, the literature regarding prevention strategies and the presentation of spinal metastases has remained scarce. As local control of primary lesions continues to improve, more cases of spinal metastases are likely to be seen. In this review the authors present a new case of metastatic GBM to the L-5 nerve root, and they summarize previous cases of intracranial GBM with leptomeningeal spinal metastatic disease. They also characterize key features of this disease presentation and discuss areas of future investigation necessary for enhanced prevention and treatment of this complication.

Abbreviation used in this paper:GBM = glioblastoma multiforme.

Article Information

Address correspondence to: Zachary A. Smith, M.D., Department of Neurological Surgery, Suite 2210, Northwestern University, 676 North St. Clair Street, Chicago, Illinois 60661. email: zsmithmd@gmail.com.

Please include this information when citing this paper: published online September 7, 2012; DOI: 10.3171/2012.7.SPINE12212.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal T1-weighted MR images demonstrating a contrastenhanced lesion at L-3 (left) and C-6 (right). Reproduced with permission from Hübner et al: Acta Neurochir (Wien) 143:25–29, 2001.

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    Sagittal T1-weighted MR images demonstrating multiple contrast-enhancing lesions in the conus medullaris and cauda equina (left) and a more lateral view of these same lesions (right). Reproduced with permission from Buhl et al: Acta Neurochir (Wien) 140:1001–1005, 1998.

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    Sagittal (upper) and axial (lower) Gd-enhanced T1-weighted MR images demonstrating a significant enhancing S1–2 level enhancing mass (arrows) with slight eccentricity to the left. A second area of enhancement can also be seen at L1–2 (upper).

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    Artist's illustration of the minimally invasive approach used to biopsy a lumbosacral mass. Pathological diagnosis confirmed the presence of an S-1 nerve root–associated high-grade glioma. A minimally invasive approach may decrease pain and morbidity in patients with a high disease burden. Printed with the permission of Lydia M. Johns, 2012.

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