neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2022-24-4-118-123neurosurgery-1296Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWИнтрамедуллярные метастазы: современное состояние проблемыIntramedullary spinal cord metastases: current state of the problemhttps://orcid.org/0000-0002-8581-9546ОвчинниковВ. А.OvchinnikovV. A.

Владислав Алексеевич Овчинников

105203 Москва,  ул. Нижняя Первомайская, 70

Vladislav Alekseevich Ovchinnikov

70 Nizhnyaya Pervomayskaya St., Moscow 105203

ovchinnikov.va96@gmail.comhttps://orcid.org/0000-0003-2974-1462ЗуевА. А.ZuevA. A.

105203 Москва,  ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203

ФГБУ «Национальный медико-хирургический центр им. Н. И. Пирогова» Минздрава РоссииРоссияN. I. Pirogov National Medical and Surgical Center of the Ministry of Health of RussiaRussian Federation202227122022244118123Copyright © Овчинников В.А., Зуев А.А., 20222022Овчинников В.А., Зуев А.А.Ovchinnikov V.A., Zuev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1296

Интрамедуллярные метастазы – достаточно редкое проявление основного онкологического заболевания. Их развитие заметно снижает качество жизни и указывает на неблагоприятный прогноз. Отсутствие патогномоничных симптомов препятствует быстрому и точному выявлению данной патологии, что приводит к поздней постановке диагноза. К основным методам лечения спинальных метастазов относят: хирургическое лечение, стероидную, лучевую и химиотерапию. Уточнение алгоритмов диагностики и оптимизация протоколов ведения пациентов с интрамедуллярными метастазами может улучшить выживаемость пациентов и положительно повлиять на общий прогноз.

В статье освещены вопросы эпидемиологии, механизмов метастазирования, клинической картины, современных методов диагностики и лечения интрамедуллярных метастазов, а также представлен обзор исходов при данной патологии.

Intramedullary metastases are a rather rare manifestation of the underlying cancer. Their presence indicates an unfavorable prognosis and leads to a noticeable decrease in the quality of life. The absence of pathognomonic symptoms prevents the rapid and accurate identification of this pathology, which leads to a late diagnosis. The main methods of treating spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy. Refining diagnostic algorithms and optimizing protocols for managing patients with intramedullary metastases can help play a role in improving overall prognosis and patient survival. The review covers the epidemiology, the mechanisms of metastasis, the clinical picture, modern methods of diagnosis and treatment of intramedullary metastases, as well as the outcomes of this pathology. The main methods of treatment of spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy.

интрамедуллярные метастазыметастатическое поражение центральной нервной системыспинной мозглечение интрамедуллярных опухолейintramedullary spinal cord metastasesmetastatic lesions of the central nervous systemspinal cordtreatment of intramedullary tumorsReferencesCostigan D.A., Winkelman M.D. Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases. J Neurosurg 1985;62(2):227–33. DOI: 10.3171/jns.1985.62.2.0227Costigan D.A., Winkelman M.D. Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases. J Neurosurg 1985;62(2):227–33. DOI: 10.3171/jns.1985.62.2.0227O’Neill A.H., Phung T.B., Lai L.T. Intramedullary spinal cord metastasis from thyroid carcinoma: case report and a systematic pooled analysis of the literature. J Clin Neurosci 2018;49:7–15. DOI: 10.1016/j.jocn.2017.12.001O’Neill A.H., Phung T.B., Lai L.T. Intramedullary spinal cord metastasis from thyroid carcinoma: case report and a systematic pooled analysis of the literature. J Clin Neurosci 2018;49:7–15. DOI: 10.1016/j.jocn.2017.12.001Lv J., Liu B., Quan X. et al. Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review. Onco Targets Ther 2019;12:4741–53. DOI: 10.2147/OTT.S193235Lv J., Liu B., Quan X. et al. Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review. Onco Targets Ther 2019;12:4741–53. DOI: 10.2147/OTT.S193235Wewel J.T., O’Toole J.E. Epidemiology of spinal cord and column tumors. Neurooncol Pract 2020;7(Suppl 1):i5–9. DOI: 10.1093/nop/npaa046Wewel J.T., O’Toole J.E. Epidemiology of spinal cord and column tumors. Neurooncol Pract 2020;7(Suppl 1):i5–9. DOI: 10.1093/nop/npaa046Abdulazim A., Backhaus M., Stienen M.N. et al. Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma. J Clin Neurosci 2011;18(10):1405–7. DOI: 10.1016/j.jocn.2011.01.039Abdulazim A., Backhaus M., Stienen M.N. et al. Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma. J Clin Neurosci 2011;18(10):1405–7. DOI: 10.1016/j.jocn.2011.01.039Jayakumar N., Ismail H, Athar S., Ashwood N. Perineural invasion in intramedullary spinal cord metastasis. Ann R Coll Surg Engl 2020;102(5):e94–6. DOI: 10.1308/rcsann.2020.0009Jayakumar N., Ismail H, Athar S., Ashwood N. Perineural invasion in intramedullary spinal cord metastasis. Ann R Coll Surg Engl 2020;102(5):e94–6. DOI: 10.1308/rcsann.2020.0009Goyal A., Yolcu Y., Kerezoudis P. et al. Intramedullary spinal cord metastases: an institutional review of survival and outcomes. J Neurooncol 2019;142(2):347–54. DOI: 10.1007/s11060-019-03105-2Goyal A., Yolcu Y., Kerezoudis P. et al. Intramedullary spinal cord metastases: an institutional review of survival and outcomes. J Neurooncol 2019;142(2):347–54. DOI: 10.1007/s11060-019-03105-2Weng Y., Zhan R., Shen J. et al. Intramedullary spinal cord metastasis from renal cell carcinoma: a systematic review of the literature. Biomed Res Int 2018;2018:7485020. DOI: 10.1155/2018/7485020Weng Y., Zhan R., Shen J. et al. Intramedullary spinal cord metastasis from renal cell carcinoma: a systematic review of the literature. Biomed Res Int 2018;2018:7485020. DOI: 10.1155/2018/7485020Khoshnevisan A., Abdollahzade S., Jahanzad I. et al. Intramedullary spinal cord metastasis from endometrioid adenocarcinoma. Arch Iran Med 2014;17(4):293–6. DOI: 014174/AIM.0013Khoshnevisan A., Abdollahzade S., Jahanzad I. et al. Intramedullary spinal cord metastasis from endometrioid adenocarcinoma. Arch Iran Med 2014;17(4):293–6. DOI: 014174/AIM.0013Payer S., Mende K.C., Westphal M., Eicker S.O. Intramedullary spinal cord metastases: an increasingly common diagnosis. Neurosurg Focus 2015;39(2):e15. DOI: 10.3171/2015.5.FOCUS15149Payer S., Mende K.C., Westphal M., Eicker S.O. Intramedullary spinal cord metastases: an increasingly common diagnosis. Neurosurg Focus 2015;39(2):e15. DOI: 10.3171/2015.5.FOCUS15149Sung W.S., Chan J.H., Manion B. et al. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 2013;79(3–4):576–84. DOI: 10.1016/j.wneu.2012.04.005Sung W.S., Chan J.H., Manion B. et al. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 2013;79(3–4):576–84. DOI: 10.1016/j.wneu.2012.04.005Lee S.S., Kim M.K., Sym S.J. et al. Intramedullary spinal cord metastases: a single-institution experience. J Neurooncol 2007;84(1):85–9. DOI: 10.1007/s11060-007-9345-zLee S.S., Kim M.K., Sym S.J. et al. Intramedullary spinal cord metastases: a single-institution experience. J Neurooncol 2007;84(1):85–9. DOI: 10.1007/s11060-007-9345-zPotti A., Abdel-Raheem M., Levitt R. et al. Intramedullary spinal cord metastases (ISCM) and non-small cell lung carcinoma (NSCLC): clinical patterns, diagnosis and therapeutic considerations. Lung Cancer 2001;31(2–3):319–23. DOI: 10.1016/s0169-5002(00)00177-xPotti A., Abdel-Raheem M., Levitt R. et al. Intramedullary spinal cord metastases (ISCM) and non-small cell lung carcinoma (NSCLC): clinical patterns, diagnosis and therapeutic considerations. Lung Cancer 2001;31(2–3):319–23. DOI: 10.1016/s0169-5002(00)00177-xFranzoi M.A., Hortobagyi G.N. Leptomeningeal carcinomatosis in patients with breast cancer. Crit Rev Oncol Hematol 2019;135:85–94. DOI: 10.1016/j.critrevonc.2019.01.020Franzoi M.A., Hortobagyi G.N. Leptomeningeal carcinomatosis in patients with breast cancer. Crit Rev Oncol Hematol 2019;135:85–94. DOI: 10.1016/j.critrevonc.2019.01.020Wang N., Bertalan M.S., Brastianos P.K. Leptomeningeal metastasis from systemic cancer: review and update on management. Cancer 2018;124(1):21–35. DOI: 10.1002/cncr.30911Wang N., Bertalan M.S., Brastianos P.K. Leptomeningeal metastasis from systemic cancer: review and update on management. Cancer 2018;124(1):21–35. DOI: 10.1002/cncr.30911Taillibert S., Chamberlain M.C. Leptomeningeal metastasis. Handb Clin Neurol 2018;149:169–204. DOI: 10.1016/B978-0-12-811161-1.00013-XTaillibert S., Chamberlain M.C. Leptomeningeal metastasis. Handb Clin Neurol 2018;149:169–204. DOI: 10.1016/B978-0-12-811161-1.00013-XLiebig C., Ayala G., Wilks J.A. et al. Perineural invasion in cancer: a review of the literature. Cancer 2009;115(15):3379–91. DOI: 10.1002/cncr.24396Liebig C., Ayala G., Wilks J.A. et al. Perineural invasion in cancer: a review of the literature. Cancer 2009;115(15):3379–91. DOI: 10.1002/cncr.24396Ginalis E.E., Jumah F., Raju B. et al. Intramedullary spinal cord metastasis from primary lung neuroendocrine carcinoma: a case report and operative video. World Neurosurg 2021;145:426–31. DOI: 10.1016/j.wneu.2020.08.103Ginalis E.E., Jumah F., Raju B. et al. Intramedullary spinal cord metastasis from primary lung neuroendocrine carcinoma: a case report and operative video. World Neurosurg 2021;145:426–31. DOI: 10.1016/j.wneu.2020.08.103Крылов В.В., Евзиков Г.Ю. Коновалов Н.А. и др. Хирургическое лечение интрамедуллярных опухолей. М.: Толикети, 2019. С. 22–6.Krylov V.V., Evzikov G.Yu., Konovalov N.A. et al. Surgical treatment of intramedullary tumors. Moscow: Toliketi, 2019. Pp. 22–6. (In Russ.).McCormick P.C., Stein B.M. Intramedullary tumors in adults. Neurosurg Clin N Am 1990;1(3):609–30. DOI: 10.3171/jns.1990.72.4.0523McCormick P.C., Stein B.M. Intramedullary tumors in adults. Neurosurg Clin N Am 1990;1(3):609–30. DOI: 10.3171/jns.1990.72.4.0523Grem J.L., Burgess J., Trump D.L. Clinical features and natural history of intramedullary spinal cord metastasis. Cancer 1985;56(9):2305–14. DOI: 10.1002/1097-0142(19851101)56:93.0.co;2-xGrem J.L., Burgess J., Trump D.L. Clinical features and natural history of intramedullary spinal cord metastasis. Cancer 1985;56(9):2305–14. DOI: 10.1002/1097-0142(19851101)56:93.0.co;2-xVeeravagu A., Chen Yi.R., Lieberson R. et al. Intramedullary spinal cord metastasis: diagnosis and management. Contemporary Neurosurgery 2012;34(22):1–5. DOI: 10.1097/01.CNE.0000422050.87239.25Veeravagu A., Chen Yi.R., Lieberson R. et al. Intramedullary spinal cord metastasis: diagnosis and management. Contemporary Neurosurgery 2012;34(22):1–5. DOI: 10.1097/01.CNE.0000422050.87239.25Schijns O.E., Kurt E., Wessels P. et al. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000;102(4):249–54. DOI: 10.1016/s0303-8467(00)00106-2Schijns O.E., Kurt E., Wessels P. et al. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000;102(4):249–54. DOI: 10.1016/s0303-8467(00)00106-2Saeed H., Patel R., Thakkar J. et al. Multimodality therapy improves survival in intramedullary spinal cord metastasis of lung primary. Hematol Oncol Stem Cell Ther 2017;10(3):143–50. DOI: 10.1016/j.hemonc.2017.07.003Saeed H., Patel R., Thakkar J. et al. Multimodality therapy improves survival in intramedullary spinal cord metastasis of lung primary. Hematol Oncol Stem Cell Ther 2017;10(3):143–50. DOI: 10.1016/j.hemonc.2017.07.003Diehn F.E., Rykken J.B., Wald J.T. et al. Intramedullary spinal cord metastases: MRI and relevant clinical features from a 13-year institutional case series. Am J Neuroradiol 2013;34(10):2043–9. DOI: 10.3174/ajnr.A3526Diehn F.E., Rykken J.B., Wald J.T. et al. Intramedullary spinal cord metastases: MRI and relevant clinical features from a 13-year institutional case series. Am J Neuroradiol 2013;34(10):2043–9. DOI: 10.3174/ajnr.A3526Rykken J.B., Diehn F.E., Hunt C.H. et al. Rim and flame signs: postgadolinium MRI findings specific for non-CNS intramedullary spinal cord metastases. AJNR Am J Neuroradiol 2013;34(4): 908–15. DOI: 10.3174/ajnr.A3292Rykken J.B., Diehn F.E., Hunt C.H. et al. Rim and flame signs: postgadolinium MRI findings specific for non-CNS intramedullary spinal cord metastases. AJNR Am J Neuroradiol 2013;34(4): 908–15. DOI: 10.3174/ajnr.A3292Mostardi P.M., Diehn F.E., Rykken J.B. et al. Intramedullary spinal cord metastases: visibility on PET and correlation with MRI features. Am J Neuroradiol 2014;35(1):196–201. DOI: 10.3174/ajnr.A3618Mostardi P.M., Diehn F.E., Rykken J.B. et al. Intramedullary spinal cord metastases: visibility on PET and correlation with MRI features. Am J Neuroradiol 2014;35(1):196–201. DOI: 10.3174/ajnr.A3618Sahel O.A., Bazine A., Nabih S.O. et al. Unsuspected Intramedullary Spinal Cord Metastasis Detected by FDG PET/CT. Indian J Nucl Med 2020;35(4):353–4. DOI: 10.4103/ijnm.IJNM_150_20Sahel O.A., Bazine A., Nabih S.O. et al. Unsuspected Intramedullary Spinal Cord Metastasis Detected by FDG PET/CT. Indian J Nucl Med 2020;35(4):353–4. DOI: 10.4103/ijnm.IJNM_150_20Ehret F., Senger C., Kufeld M. et al. Image-guided robotic radiosurgery for the management of intramedullary spinal cord metastases – a multicenter experience. Cancers (Basel) 2021;13(2):297. DOI: 10.3390/cancers13020297Ehret F., Senger C., Kufeld M. et al. Image-guided robotic radiosurgery for the management of intramedullary spinal cord metastases – a multicenter experience. Cancers (Basel) 2021;13(2):297. DOI: 10.3390/cancers13020297Veeravagu A., Lieberson R.E., Mener A. et al. CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J Clin Neurosci 2012;19(9):1273–7. DOI: 10.1016/j.jocn.2012.02.002Veeravagu A., Lieberson R.E., Mener A. et al. CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J Clin Neurosci 2012;19(9):1273–7. DOI: 10.1016/j.jocn.2012.02.002Kalayci M., Cagavi F., Gul S. et al. Intramedullary spinal cord metastases: diagnosis and treatment – an illustrated review. Acta Neurochir (Wien) 2004;146(12):1347–54. DOI: 10.1007/s00701-004-0386-1Kalayci M., Cagavi F., Gul S. et al. Intramedullary spinal cord metastases: diagnosis and treatment – an illustrated review. Acta Neurochir (Wien) 2004;146(12):1347–54. DOI: 10.1007/s00701-004-0386-1Matsumoto H., Shimokawa N., Sato H. et al. Intramedullary spinal cord metastasis of gastric cancer. J Craniovertebr Junction Spine 2021;12(1):77–80. DOI: 10.4103/jcvjs.JCVJS_163_20Matsumoto H., Shimokawa N., Sato H. et al. Intramedullary spinal cord metastasis of gastric cancer. J Craniovertebr Junction Spine 2021;12(1):77–80. DOI: 10.4103/jcvjs.JCVJS_163_20Dam-Hieu P., Seizeur R., Mineo J.F. et al. Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 2009;111(1):10–7. DOI: 10.1016/j.clineuro.2008.06.019Dam-Hieu P., Seizeur R., Mineo J.F. et al. Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 2009;111(1):10–7. DOI: 10.1016/j.clineuro.2008.06.019Gasser T., Sandalcioglu I.E., El Hamalawi B. et al. Surgical treatment of intramedullary spinal cord metastases of systemic cancer: functional outcome and prognosis. J Neurooncol 2005;73(2):163–8. DOI: 10.1007/s11060-004-4275-5Gasser T., Sandalcioglu I.E., El Hamalawi B. et al. Surgical treatment of intramedullary spinal cord metastases of systemic cancer: functional outcome and prognosis. J Neurooncol 2005;73(2):163–8. DOI: 10.1007/s11060-004-4275-5Kalita O. Current insights into surgery for intramedullary spinal cord metastases: a literature review. Int J Surg Oncol 2011;2011:989506. DOI: 10.1155/2011/989506Kalita O. Current insights into surgery for intramedullary spinal cord metastases: a literature review. Int J Surg Oncol 2011;2011:989506. DOI: 10.1155/2011/989506Holoye P.Y., Libnoch J.A., Anderson T. et al. Combined methotrexate and high-dose vincristine chemotherapy with radiation therapy for small cell bronchogenic carcinoma. Cancer 1985;55(7):1436–45. DOI: 10.1002/1097-0142(19850401)55: 73.0.co;2-9Holoye P.Y., Libnoch J.A., Anderson T. et al. Combined methotrexate and high-dose vincristine chemotherapy with radiation therapy for small cell bronchogenic carcinoma. Cancer 1985;55(7):1436–45. DOI: 10.1002/1097-0142(19850401)55: 73.0.co;2-9Grasso G., Meli F., Patti R. et al. Intramedullary spinal cord tumor presenting as the initial manifestation of metastatic colon cancer: case report and review of the literature. Spinal Cord 2007;45(12):793–6. DOI: 10.1038/sj.sc.3102105Grasso G., Meli F., Patti R. et al. Intramedullary spinal cord tumor presenting as the initial manifestation of metastatic colon cancer: case report and review of the literature. Spinal Cord 2007;45(12):793–6. DOI: 10.1038/sj.sc.3102105Phillips K.A., Gaughan E., Gru A., Schiff D. Regression of an intramedullary spinal cord metastasis with a checkpoint inhibitor: a case report. CNS Oncol 2017;6(4):275–80. DOI: 10.2217/cns-2017-0007Phillips K.A., Gaughan E., Gru A., Schiff D. Regression of an intramedullary spinal cord metastasis with a checkpoint inhibitor: a case report. CNS Oncol 2017;6(4):275–80. DOI: 10.2217/cns-2017-0007

The authors declare that there are no conflicts of interest present.