Comprehensive Treatment for Spinal Cord Metastases of Malignant Gliomas : A Case Report

Abstract

We report on a 39‒year‒old man who developed spinal cord metastases of malignant gliomas, for whom comprehensive treatment was effective. He presented with headache and nausea, and magnetic resonance imaging(MRI)revealed a tumor lesion of 4 cm in the right cerebellar hemisphere. After undergoing craniotomy, he was diagnosed with glioblastomas(World Health Organization[WHO]grade IV), and chemo‒radiation therapy was thus performed. However, subsequent recurrence led to blindness in his left eye;therefore, he underwent stereotactic radiotherapy, and almost complete recovery of visual acuity was observed. One year later, the patient developed buttock pain and gait disturbance, and he experienced severe paralysis symptoms in both lower limbs and difficulty walking. Whole spine MRI revealed spinal cord metastases, and surgical biopsy indicated that he had glioblastomas(WHO grade IV). The patient underwent CyberKnife(3,300 cGy in 5 fractions)as a post‒operative treatment, and bevacizumab was administered every 2 weeks. Paralysis symptoms of both lower limbs improved from 2 days after irradiation with CyberKnife, and 2 months later, he was discharged on foot. To the best of our knowledge, this case report is the first to show that comprehensive treatment with CyberKnife is effective for spinal cord metastases of malignant gliomas. However, the standard therapy for spinal cord metastases of malignant gliomas has not been established, and radiotherapy only controls symptoms but does not extend survival time. Therefore, further studies are needed to investigate whether comprehensive treatment with CyberKnife extends survival time for patients with symptomatic spinal cord metastasis. (Received January 9, 2019;accepted February 18, 2019)