Intradural Extramedullary Spinal Cord Malignancy Treated With Percutaneous Image-Guided Cryoablation.

A 63-year-old male with several months of bilateral gluteal radicular pain and changes in bowel and bladder function presented with an acute onset of cauda equina syndrome. Evaluation and diagnostic imaging revealed an intradural extramedullary spinal tumor at L4. The patient's symptoms were severe enough to require the use of a wheelchair and high doses of narcotic pain medication. Over the next 18 months, he would suffer from persistent bilateral gluteal and lower extremity radiculopathy, paresthesia, lower extremity weakness and paralysis, erectile dysfunction, bowel sphincter and bladder sphincter dysfunction, and disequilibrium. Initially, the tumor was resected, and the initial cytopathology impression was felt to be in error, resulting in a second opinion analysis, as well as a second tumor biopsy, generating a third cytopathological report. The three cyto-pathology reports were conflicting, with the analysis ranging from benign to malignant tumors. The final cytopathological diagnosis was indicative of a malignant teratoma with sarcoma transformation. The second recurrence was treated with chemotherapy, followed by spinal artery immunotherapy embolization. Both treatments failed. The rapid recurrence was suggestive of somatic malignant transformation within the tumor. CT-guided percutaneous cryoablation achieved a cure with no residual viable tumor, and the patient remains cancer-free one year post cryoablation. Over the months following cryoablation, the patient's neurological system recovered. At one year post-cryoablation, the patient is now pain-free without medication, fully ambulatory, and has had some return of bowel function. He has returned to work as a physician and clinic administrator.