Rationale: Multiple myeloma (MM) is a common hematologic malignancy characterized by widespread systemic involvement. Radiation therapy is the 1st-line treatment for MM patients with brain metastases in clinical practice, whereas surgical intervention is only sporadically reported in special cases. Patient concerns: A MM patient receiving conventional chemotherapy presented with progressive motor dysfunction of the right limb. Imaging examinations revealed a space-occupying lesion in the left parietal lobe. Diagnoses: Following multidisciplinary consultation involving hematology and neurosurgery departments, the patient was diagnosed with central nervous system multiple myeloma (CNS-MM). Interventions: Prompt symptomatic treatments, including intracranial pressure reduction and antiepileptic therapy, were initiated, but the patient’s muscle strength continued to deteriorate to grade II. A left parietal lobe brain tumor resection was then performed after comprehensive evaluation. Outcomes: Postoperatively, the patient’s muscle strength recovered rapidly, and no tumor recurrence was noted during follow-up. However, the patient eventually died of uncontrolled pulmonary Staphylococcus aureus infection. Lessons: CNS-MM is associated with a poor prognosis, and the current treatment strategies remain suboptimal. Surgical intervention may be a viable option for patients with rapidly progressive CNS-MM. This case comprehensively analyzes the potential benefits of surgical treatment for specific CNS-MM patients, based on existing treatment protocols and relevant case reports.
Shen et al. (Fri,) studied this question.