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Case Report

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Spinal Intradural Intramedullary Dissemination in the Absence of Intracranial Relapse of a Previously Radically Treated Temporal Lobe Glioblastoma Multiforme

Serrano L.a · Archavlis E.a · Januschek E.b · Timofeev P.b · Ulrich P.b

Author affiliations

aDepartment of Neurosurgery, Mainz University Hospital, Mainz, Germany
bDepartment of Neurosurgery, Sana Klinikum Offenbach, Offenbach, Germany

Corresponding Author

Dr. Lucas Serrano

Department of Neurosurgery

Mainz University Hospital

Langenbeckstrasse 1, DE–55131 Mainz (Germany)

E-Mail Lucas.Serrano@unimedizin-mainz.de

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Case Rep Oncol 2017;10:281–289

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Intracranial glioblastoma multiforme (GBM) constitutes the most frequent and unfortunately aggressive primary central nervous system malignancy. Despite the high tendency of these tumors to show local relapse within the brain after primary therapy, dissemination into the spinal axis is an infrequent event. If spinal metastases occur they are leptomeningeal in the vast majority of cases and always in the context of intracranial progressive disease. Spinal intramedullary metastases of intracranial GBM have rarely been described to date. We report the unique case of a young woman with subacute progressive paraparesis due to spinal intramedullary metastases of a temporal lobe GBM despite the remarkable absence of intracranial tumor relapse. The patient had undergone gross total resection of a left temporal GBM in contact with the ventricles and cisternal space followed by radio- and chemotherapy 13 months before. At the moment of diagnosis of spinal intramedullary metastases, there were no signs of intracranial tumor recurrence as revealed by MRI scans. Since a high level of suspicion may be needed to detect this rare evolution of intracranial GBM and other differential diagnoses must be ruled out at presentation, we discuss the important features of this case regarding clinical manifestation, diagnosis, surgery, and management. Furthermore, we mention possible factors that may have contributed to the development of these metastases in the context of intracranial remission.

© 2017 The Author(s). Published by S. Karger AG, Basel


  1. Mehta M, Vogelbaum MA, Chang S: Neoplasms of the central nervous system; in DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology, ed 9. Philadelphia, Lippincott Williams & Wilkins, 2011, pp 1700–1749.
  2. Davis FG, Freels S, Grutsch J, Barlas S, Brem S: Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology and end Results (SEER) data, 1973–1991. J Neurosurg 1998;88: 1–10.
  3. Scoccianti S, Detti B, Meattini I, Iannalfi A, Sardaro A, Leonulli BG, Martinelli F, Bordi L, Pellicanò G, Biti G: Symptomatic leptomeningeal and intramedullary metastases from intracranial glioblastoma multiforme: a case report. Tumori 2008;94: 877–881.
    External Resources
  4. Birbilis TA, Matis GK, Eleftheriadis SG, Theodoropoulou EN, Sivridis E: Spinal metastasis of glioblastoma multiforme: an uncommon suspect? Spine 2010;35: 264–269.
  5. Tinchon A, Oberndorfer S, Marosi C, Rudà R, Sax C, Calabek B, Grisold W: Malignant spinal cord compression in cerebral glioblastoma multiforme: a multicenter case series and review of the literature. J Neurooncol 2012;110: 221–226.
  6. Lomax AJ, Yannakou CK, Rosenthal MA: Spinal cord metastasis in a patient treated with bevacizumab for glioblastoma. Target Oncol 2013;8: 153–155.
  7. Choi P, Shapera S: What’s your call? Drop metastases. CMAJ 2006;175: 475–477.
  8. Chow TS, McCutcheon IE: The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment. J Neurosurg 1996;85: 225–230.
  9. Erlich SS, Davis RL: Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 1978;42: 2854–2864.
  10. Lam CH, Cosgrove GR, Drislane FW, Sotrel A: Spinal leptomeningeal metastasis from cerebral glioblastoma. Appearance on magnetic resonance imaging. Surg Neurol 1991;35: 377–380.
  11. Buhl R, Barth H, Hugo HH, Hutzelmann A, Mehdorn HM: Spinal drop metastases in recurrent glioblastoma multiforme. Acta Neurochir 1998;140: 1001–1005.
  12. Stark AM, Nabavi A, Mehdorn HM, Blömer U: Glioblastoma multiforme – report of 267 cases treated at a single institution. Surg Neurol 2005;63: 162–169.
  13. Karaca M, Andrieu MN, Hicsonmez A, Guney Y, Kurtman C: Cases of glioblastoma multiforme metastasizing to spinal cord. Neurol India 2006;54: 428–430.
  14. Maslehaty H, Cordovi S, Hefti M: Symptomatic spinal metastases of intracranial glioblastoma: clinical characteristics and pathomechanism relating to GFAP expression. J Neurooncol 2011;101: 329–333.
  15. Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F: Cerebral glioblastoma with cerebrospinal fluid dissemination: a clinicopathological study of 14 cases examined by complete autopsy. Neurosurgery 1989;25: 533–540.
  16. Kuo LT, Tsai SY, Yang CY, Lin LW: Meningeal seeding from glioblastoma multiforme treated with radiotherapy and temozolomide. Asian J Surg 2017;40: 61–65.
  17. Hamilton MG, Tranmer BI, Hagen NA: Supratentorial glioblastoma with spinal cord intramedullary metastasis. Can J Neurol Sci 1993;20: 65–68.
  18. Baser ME, Friedman JM, Joe H, Shenton A, Wallace AJ, Ramsden RT, Evans DG: Empirical development of improved diagnostic criteria for neurofibromatosis 2. Genet Med 2011;13: 576–581.
  19. Wagner LM, Zhou H, Brockmeyer DL, Hedlund GL: Spinal cord schwannomas mimicking drop metastases in a patient with intramedullary ependymoma and neurofibromatosis 2. J Pediatr Hematol Oncol 2004;26: 56–59.
  20. Albert G, Wassef S, Dahdaleh N, Lindley T, Bruch L, Hitchon P: Intracranial glioblastoma with drop metastases to the spine after stereotactic biopsy. J Neurol Surg A Cent Eur Neurosurg 2013;74: 221–224.
  21. Grabb PA, Albright AL, Pang D: Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 1992;30: 64–71.
  22. Cairns H, Russell DS: Intracranial and spinal metastases in gliomas of the brain. Brain 1931;54: 377–420.
  23. Shah A, Redhu R, Nadkarni T, Goel A: Supratentorial glioblastoma multiforme with spinal metastases. J Craniovertebr Junction Spine 2010;1: 126–129.
  24. 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: 33–37.
  25. Tseng HM, Kuo LT, Lien HC, Liu KL, Liu MT, Huang CY: Prolonged survival of a patient with cervical intramedullary glioblastoma multiforme treated with total resection, radiation therapy, and temozolomide. Anticancer Drugs 2010;21: 963–967.
  26. Chamoun RB, Alaraj AM, Al Kutoubi AO, Abboud MR, Haddad GF: Role of temozolomide in spinal cord low grade astrocytomas: results in two paediatric patients. Acta Neurochir 2006; 148: 175–179.

Article / Publication Details

Received: February 17, 2017
Accepted: February 17, 2017
Published online: March 29, 2017
Issue release date: January – April

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 0

eISSN: 1662-6575 (Online)

For additional information: https://www.karger.com/CRO

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