Intradural cauda equina metastases from renal cell carcinoma

Background: Intradural metastases to the cauda equina from renal cell carcinoma are exceptional, with only 14 reported cases in the literature. This article reports a further case and discusses the indications and limits of the surgery and the best management. Case report:: A 64-year-old man was observed because of sudden onset of intense radicular pain in the left L5 territory. Fourteen years before he underwent right nephrectomy for a clear renal cell carcinoma. MRI revealed two intradural metastatic lesions at L1-L2 and L4-L5 levels, respectively. Surgical resection of the symptomatic L4-L5 lesion, radiotherapy and chemotherapy were performed. The histological and immunohistochemical studies confirmed the diagnosis of metastatic renal cell carcinoma. The treatment resulted in remission of the radicular pain with no neurological deficits. The patient was symptom-free at one year follow-up. Conclusion: Intradural metastases to the cauda from renal cell carcinoma are exceptional. Surgery is the first option in selected patients with stable neoplastic disease, good Karnofsky Performance Status (KPS > 70), intense radicular pain and progressive neurological symptoms. The tumor resection, even incomplete, results in clinical improvement.