Intradural metastases of chordoma.

A 59-year-old man with sacral chordoma had several resections of locally recurring disease during a 6-year period following diagnosis. The present hospital admission of the patient, now 65, was prompted by several weeks of pain in the right buttock and progressive difficulty in walking. A tender soft-tissue mass in the right buttock area, weakness and muscle atrophy of both lower extremities, and decreased sensation in the distribution of the fourth lumbar root bilaterally were noted on physical examination . CT showed a large posterior pelvic mass with destruction of the sacrum extending up to the L4 vertebra. MR revealed a sacral mass, confined to the pelvis and lower lumbar spine, but no abnormalities above the L4 level. Multiple intradural nodular lesions were demonstrated in the lumbar sac on metrizamide myelography (Fig. 1). A palliative surgical procedure and laminectomy up to the L 1 level were carried out. The main tumor mass was debulked and multiple intradural tumor nodules were resected from the lumbar arachnoid sac. Pathology revealed chordoma. The patient's condition improved significantly after surgery, but he returned with similar symptoms 6 months later.