{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:37:32Z","timestamp":1792276652756,"version":"4.4.0"},"reference-count":14,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"published-print":{"date-parts":[[1970,12,1]]},"DOI":"10.1136\/jnnp.33.6.763","type":"journal-article","created":{"date-parts":[[2008,11,10]],"date-time":"2008-11-10T21:02:42Z","timestamp":1226350962000},"page":"763-770","source":"Crossref","is-referenced-by-count":50,"title":["Extraneural metastases in ependymoma of the cauda equina"],"prefix":"10.1136","volume":"33","author":[{"given":"L. J.","family":"Rubinstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. J.","family":"Logan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","reference":[{"key":"ref_1","article-title":"Patterson et","author":"al","year":"1961","unstructured":"Patterson et al (1961)"},{"key":"ref_2","article-title":"tumour' with 'definite glial pattern histologically', in a male, aged 24 at death, who developed metastases in the lung after a total course of 10 months. This case is unlikely to fall into the present group, since it closely resembled a medulloblastoma. The case interpreted by Watt","volume-title":"as an ependymoma of the cauda equina with distant metastases, in a 56 year old woman who had a large cavity in the upper lobe of the left lung and two distinct tumours in the cerebrum, is unacceptable, since the clinical features, gross findings, and microscopical description all point, in our view, to a metastatic","author":"adenocarcinoma, in all probability bronchogenic","year":"1968","unstructured":"tumour' with 'definite glial pattern histologically', in a male, aged 24 at death, who developed metastases in the lung after a total course of 10 months. This case is unlikely to fall into the present group, since it closely resembled a medulloblastoma. The case interpreted by Watt (1968) as an ependymoma of the cauda equina with distant metastases, in a 56 year old woman who had a large cavity in the upper lobe of the left lung and two distinct tumours in the cerebrum, is unacceptable, since the clinical features, gross findings, and microscopical description all point, in our view, to a metastatic adenocarcinoma, in all probability bronchogenic."},{"key":"ref_3","article-title":"The pathway of distant dissemination, in this as well as in the other reported cases, is presumed to have occurred via the blood stream. The frequency with which, in published reports, venous permeation is noted to have occurred in gliomas with extraneural metastasis has previously been emphasized. This feature has also been demonstrated in the exceptional instance in which extracranial deposits developed in the absence of previous craniotomy (Rubinstein, 1967). Whereas in some cases venous invasion was recorded only in distant sites, particularly the lungs, in some examples it was found at the primary locus, either in a main sinus or in dural veins within the intracranial cavity, or, as in the cases reviewed in this report, in the large pelvic and abdominal veins. The present observation therefore reinforces the view that, although venous permeation by a glioma is extremely rare, it should, when demonstrated at the primary site, be regarded as a harbinger of distant metastatic spread","unstructured":"The pathway of distant dissemination, in this as well as in the other reported cases, is presumed to have occurred via the blood stream. The frequency with which, in published reports, venous permeation is noted to have occurred in gliomas with extraneural metastasis has previously been emphasized. This feature has also been demonstrated in the exceptional instance in which extracranial deposits developed in the absence of previous craniotomy (Rubinstein, 1967). Whereas in some cases venous invasion was recorded only in distant sites, particularly the lungs, in some examples it was found at the primary locus, either in a main sinus or in dural veins within the intracranial cavity, or, as in the cases reviewed in this report, in the large pelvic and abdominal veins. The present observation therefore reinforces the view that, although venous permeation by a glioma is extremely rare, it should, when demonstrated at the primary site, be regarded as a harbinger of distant metastatic spread."},{"key":"ref_4","first-page":"25","article-title":"Presacral and sacral tumours in children","volume":"5","author":"Christensen, E.R.","year":"1958","unstructured":"Christensen, E. R. (1958). Presacral and sacral tumours in children. Dan. med. Bull., 5, 25-32.","journal-title":"Dan. med. Bull"},{"key":"ref_5","first-page":"993","volume-title":"Primary tumors of the spinal cord and intradural filum terminale. In Cytology and Cellular Pathology of the Nervous System","volume":"3","author":"Kernohan, J.W.","year":"1932","unstructured":"Kernohan, J. W. (1932). Primary tumors of the spinal cord and intradural filum terminale. In Cytology and Cellular Pathology of the Nervous System, vol. 3, pp 993-1025, edited by W. Penfield. Hoeber: New York."},{"key":"ref_6","first-page":"351","article-title":"The effects of single doses of roentgen radiation on experimentally induced gliomas: with a critical review of the effects of roentgen radiation on gliomas in man","volume":"76","author":"Netsky, M.G.; Shapiro, J.; Hoffman, M.; Corsentino, B.; Freid, J.R.; Zimmerman, H.M.","year":"1956","unstructured":"Netsky, M. G., Shapiro, J., Hoffman, M., Corsentino, B., Freid, J. R., and Zimmerman, H. M. (1956). The effects of single doses of roentgen radiation on experimentally induced gliomas: with a critical review of the effects of roentgen radiation on gliomas in man. Amer. J. Roentgenol., 76, 351-366.","journal-title":"Amer. J. Roentgenol"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1136\/jnnp.32.2.94","article-title":"The effect of irradiation on a medulloblastoma","volume":"32","author":"Oppenheimer, D.R.","year":"1969","unstructured":"Oppenheimer, D. R. (1969). The effect of irradiation on a medulloblastoma. J. Neurol. Neurosurg. Psychiat., 32, 94-98.","journal-title":"J. Neurol. Neurosurg. Psychiat"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3171\/jns.1961.18.2.0145","article-title":"Ependymoma of the cauda equina with multiple visceral metastases. Report of a case","volume":"18","author":"Patterson, Jr., R.H.; Campbell, Jr., W.G.; Parsons, H.","year":"1961","unstructured":"Patterson, R. H., Jr., Campbell, W. G., Jr., and Parsons, H. (1961). Ependymoma of the cauda equina with multiple visceral metastases. Report of a case. J. Neurosurg., 18, 145-150.","journal-title":"J. Neurosurg"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"542","DOI":"10.3171\/jns.1967.26.5.0542","article-title":"Development of extracranial metastases from a malignant astrocytoma in the absence of previous craniotomy. Case report","volume":"26","author":"Rubinstein, L.J.","year":"1967","unstructured":"Rubinstein, L. J. (1967). Development of extracranial metastases from a malignant astrocytoma in the absence of previous craniotomy. Case report. J. Neuirosuirg., 26, 542-547.","journal-title":"J. Neuirosuirg"},{"key":"ref_10","first-page":"639","article-title":"Pathologyof Tumours of the Nervous System","volume":"10","author":"Russell, D.S.; Rubinstein, L.J.","year":"1963","unstructured":"Russell, D. S., and Rubinstein, L. J. (1963). Pathologyof Tumours of the Nervous System, 2nd edn. Edward Arnold: London. Sharma K. D. (1956). A metastasizing ependymoma of the cauda equina. Indian J. med. Sci., 10, 639-641.","edition":"2nd edn","journal-title":"Indian J. med. Sci; A metastasizing ependymoma of the cauda equina"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3171\/jns.1969.31.1.0050","article-title":"Metastasizing neuroectodermal tumors of the central nervous system","volume":"31","author":"Smith, D.R.; Hardman, J.M.; Earle, K.M.","year":"1969","unstructured":"Smith, D. R., Hardman, J. M., and Earle, K. M. (1969). Metastasizing neuroectodermal tumors of the central nervous system. J. Neurosurg., 31, 50-58.","journal-title":"J. Neurosurg"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1148\/49.1.62","article-title":"Irradiation of experimental cerebral tumours: experimental production of brain tumours in mice; some observations on effect of x-radiation on experimental gliomata in mice","volume":"49","author":"Tansley, K.; Wilson, C.W.","year":"1947","unstructured":"Tansley, K., and Wilson, C. W. (1947). Irradiation of experimental cerebral tumours: experimental production of brain tumours in mice; some observations on effect of x-radiation on experimental gliomata in mice. Radiology, 49, 62-71.","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3171\/jns.1968.29.4.0424","article-title":"Ependymoma of the cauda equina with distant metastases: case report","volume":"29","author":"Watt, V.","year":"1968","unstructured":"Watt, V. (1968). Ependymoma of the cauda equina with distant metastases: case report. J. Neurosurg., 29, 424-426.","journal-title":"J. Neurosurg"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/1097-0142(1955)8:1<161::AID-CNCR2820080123>3.0.CO;2-K","article-title":"A metastasizing ependymoma of the cauda equina","volume":"8","author":"Weiss, L.","year":"1955","unstructured":"Weiss, L. (1955). A metastasizing ependymoma of the cauda equina. 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