Intramedullary Spinal Cord Metastasis in Spinal Ependymomas

Drop metastasis, or intramedullary spinal cord metastasis (ISCM), is a rare condition accounting 0.9%–5% of CNS or spinal metastases. It arises from tumour cell dissemination through cerebrospinal fluid (CSF), often affecting the thoracic and lumbar spine. Clinical features include rapidly progressive neurological deficits, limb weakness, sensory loss, and pain. Diagnosing drop metastasis is challenging and MRI with gadolinium remains the gold standard modality for investigation. Surgical resection followed by radiotherapy remains the primary treatment option, whereas chemotherapy serves a palliative role in cases of recurrence or disseminated metastases.