Cauda equina syndrome from intradural metastasis of a non-neural tumor: case report and review of literature

• Published in: British journal of neurosurgery Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 8
• Main Authors: Pagano, Andrea, Iaquinandi, Andrea, Fraioli, Mario Francesco, Bossone, Giandominik, Carra, Nadia, Salvati, Murizio
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis 01-12-2023; Taylor & Francis Ltd
• Subjects: Back pain; cancer; Cauda Equina Syndrome; low back pain; Metastasis; paraparesis
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2021.1958155

Cauda equina syndrome (CES) is a challenging condition and it can be caused by variable entities. Leptomeningeal carcinomatosis (LC) is a multifocal seeding of the leptomeninges by malignant cells and it is observed in 1-8% of patients with solid tumors. Diagnosis of intradural metastases of the cauda equina is often delayed due to the non-specific characteristics of this condition but also to the delay of presentation of many patients. Cauda equina metastases usually occur in advanced cancers, but rarely can be the first presentation of disease.
A 63-year-old man presented with 6 months history of low back pain and 20 d history of bilateral sciatica, hypoesthesia of the legs and the saddle, flaccid paraparesis and bowel incontinence determine by multiple nodular small lesions on the entire cauda equina with contrast-enhancement. Total-body CT showed a millimetric lesion at the lung. The patient underwent L2-L5 laminectomy and subtotal removal and histological examination showed a small cell lung carcinoma metastasis.
In the literature, 54 cases of CES from non-CNS tumor metastasis are described. The diagnosis is challenging, back pain, with or without irradiation to the lower limbs, is the most frequently reported disturbance. In about 30% of patients there is no known malignancy and CES is the first clinical presentation. Treatment of choice is surgery, followed by radiotherapy and less frequently adjuvant chemotherapy. The surgical removal is almost always incomplete and functional outcome is often not satisfactory. Prognosis is poor.