Surgical Treatment of Malignant Extradural Spinal Tumours.

In these days of increasing control of malignant neoplastic disease the treatment of apparently single metastases or of inoperable but strategically situated neoplasms assumes a greater importance. There are few situations in the body where a relatively small neoplasm may cause such a major disturbance to the individual as in the spinal extradural space. This space with its rich supply of blood-vessels and lymphatics forms a common site for the implantation of metastatic deposits. It may be invaded by malignant disease from associated structures and occasionally primary neoplasms appear to arise from tissues within the space. In the past the treatment of these conditions has appeared unsatisfactory (Shenkin et al., 1945) if assessed in terms of cure or survival time. Since cure is unlikely it seemed worth while to revise and study this problem, particularly with regard to the symptomatic relief obtained using surgery supplemented by other forms of therapy. Accordingly the clinical records of 160 patients seen in the last 10 years, in whom a definite diagnosis of malignant disease in the spinal extradural space was made, have been examined. As most of these patients present a similar clinical problem-that of paraparesis of unknown origin-all types of malignant disease have been included, though some of the case material has been presented elsewhere (Bhagwati and McKissock, 1961 ; McKissock et al., 1961). Table I shows the range and incidence of the clinical material. Clearly this cannot be a true spectrum of malignant tumours in the extradural space. Comparison with other large series (Torma, 1957; Arseni et al., 1959; Botterell and Fitzgerald, 1959; Kennady and Stern, 1962) shows a different incidence of various types of disease. Selection of material