Intradural Perineural Spread of Mesothelioma Causing Myelopathy by Tethering of the Spinal Cord^[*]

Introduction

Malignant pleural mesothelioma is a rare and aggressive tumor arising from the pleura with focal invasive growth in the chest, the lung and the mediastinum and spreading to the surrounding lymph nodes.[15] In the last two decades of the 20^th century, the mortality rate more than doubled with an incubation period of 15 to 30 years.[15] Mostly the patients had a history of exposure to asbestos.[1] [15] In the final stage, hematogenous dissemination has been observed.[4] [14] The therapeutic options are chemotherapy and surgery, the aims of which are only palliative. Gene therapy and immunotherapy are at the experimental stage. Even with full treatment the median survival is 1 year from diagnosis.[15]

There are only a few cases in the literature reporting an involvement of the spinal canal with impairment of the spinal cord. Hematogenous dissemination to the dura has been observed.[4] [10] and a direct invasion of the brachial plexus with transforaminal and subsequent intraspinal growth has also been described[3] [6] [7] [8] [9] [13] [16] [17] In most cases, there is a direct impairment of the spinal cord by compression from the mesothelioma. Only four cases report invasion and subsequent spinal cord dysfunction.[6] [12] [13] [17]

We report the fifth case of mesothelioma with perineural spread. The unique feature is that the sole cause of spinal cord dysfunction is tethering.

^* This article was originally Published online in Central European Neurosurgery on July 15, 2010 (DOI:10.1055/s-0030-1253345)

• References

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