Surgical resection of lumbar intradural metastatic renal cell carcinoma

Mohamed Macki; Vardhaan S Ambati; Christine Park; Michael Tawil; Abraham Dada; Alysha Jamieson; Sean Wilkinson; Timothy Chryssikos; Praveen V Mummaneni

doi:10.3171/2023.7.FOCVID2379

Surgical resection of lumbar intradural metastatic renal cell carcinoma

Neurosurg Focus Video. 2023 Oct 1;9(2):V22. doi: 10.3171/2023.7.FOCVID2379. eCollection 2023 Oct.

Authors

Mohamed Macki¹, Vardhaan S Ambati¹, Christine Park¹, Michael Tawil¹, Abraham Dada¹, Alysha Jamieson¹, Sean Wilkinson¹, Timothy Chryssikos¹, Praveen V Mummaneni¹

Affiliation

¹ Department of Neurological Surgery, University of California, San Francisco, California.

Abstract

A 60-year-old male with renal cell carcinoma (RCC) presented with back pain, weakness, and bowel and bladder urgency. MRI demonstrated a cauda equina tumor at L2. Following L1-3 laminectomies, intraoperative ultrasound localized the tumor. After dural opening, a vascular tumor was adherent to the cauda equina. Intraoperative nerve stimulation helped to identify the nerve rootlets. Tumor was removed in a piecemeal fashion. Tumor dissection caused periodic spasms in L1-3 distributions. A neuromonitoring checklist was used to recover motor evoked potential signals with elevated mean arterial pressures. Hemostasis was challenging with the vascular tumor. Intraoperative ultrasound confirmed tumor debulking. Pathology confirmed metastatic RCC.

Keywords: cauda equina tumor; intradural tumor; intraoperative ultrasound; metastatic renal cell carcinoma; motor evoked potentials; neuromonitoring checklist; spinal metastasis.