Metastasis, case 2

Clinical history
Four months earlier, this 32-year-old male underwent surgery for a cerebellar metastasis of unknown origin. He now presents with progressive difficulty walking and weakness of his right arm and leg.

Neurological examination demonstrates a Brown-Sequard syndrome on the right at the C5 level. Degree of disability: McCormick III.

MRI
Images 1 - 3: Sagittal T1WI. In these sagittal scans of the brain, the resection site of the cerebellar metastasis is well seen, without signs of recurrence. There is however enlargement of the upper cervical spinal cord and cervical MRI was subsequently performed.
Images 4 - 6: Sagittal Gd T1WI. The cervical images confirm spinal cord enlargement due to a well-defined enhancing intramedullary lesion at the C4-C5 level.

Surgery
Video 1: metastasis
Macroscopically total removal of the tumor mass.

Stage 1: Identification of the midline.
Stage 2: Edematous spinal cord.
Stage 3: Metastasis is identified.
Stage 4: Aspiration by CUSA (Cavitron Ultrasonic Surgical Aspirator).
Stage 5: Dissection of the anterior portion of the metastasis.
Stage 6: Metastasis removed with normally pulsating cord seen.

Post-operative clinical course
The patient's clinical condition did not improve and in fact rapidly worsened, with a degree of disability three months after surgery equal to McCormick IV.
The patient died four months after surgery of multiple metastatic lesions.

Search also:
- Metastasis

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