# Surgical management of spinal intradural metastatic pathologies: a case-based review

## TL;DR

This paper reviews surgical approaches for spinal tumors that have spread to the spinal cord, highlighting surgery's role in improving patient outcomes when other treatments fail.

## Contribution

The paper introduces case-based insights into surgical management of intradural spinal metastases as a critical component of multimodal therapy.

## Key findings

- Surgical debulking can preserve mobility and alleviate pain in patients with spinal metastases.
- Combining surgery with adjuvant therapies may delay tumor recurrence and improve local control.
- Meticulous preoperative planning and intraoperative neuromonitoring are essential for successful outcomes.

## Abstract

Intradural spinal metastases significantly impair neurological function and quality of life, necessitating multimodal, palliative management to preserve mobility and alleviate pain. The effectiveness of systemic chemotherapy and radiotherapy is limited due to the blood-spinal cord barrier and the tumours’ radioresistance, respectively. This highlights the urgency for alternative treatments given the rapid neurological decline. Surgical intervention becomes crucial, focusing on maximum tumour debulking to enhance disease control, restore ambulation, and palliate symptoms without compromising neurological function. Achieving this involves meticulous preoperative planning and aggressive intraoperative neuromonitoring. Combining surgery with adjuvant therapies may improve local control and potentially delay recurrence. This case-based review emphasizes the surgical considerations and outcomes in two cases of intradural spinal metastases, underscoring the value of surgery in multimodal therapy.