Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Gamma Knife radiosurgery (GKRS) has been proven to be a successful primary treatment for metastatic brain tumors (BM). BM can come in cystic lesions and are often too large for GKRS. An alternative approach to treat cystic BM is stereotactic cyst aspiration (SCA) for volume reduction, making it suitable for GKRS afterwards.

Objective

Our objective is evaluation of volumetric reduction after SCA, tumor control, and complications after SCA directly followed by GKRS.

Methods

We performed a retrospective analysis of all patients who underwent SCA directly followed by GKRS at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg between 2002 and 2015. In total, 54 patients had undergone this combined approach. Two patients were excluded because of prior intracranial treatment. The other 52 patients were included for analysis.

Results

SCA resulted in a mean volumetric reduction of 56.5% (range 5.50–87.00%). In 83.6% of the tumors (46 tumors), SCA led to sufficient volumetric reduction making GKRS possible. The overall local tumor control (OLTC) of the aspirated lesions post-GKRS was 60.9% (28 out of 46 tumors). Median progression-free survival (PFS) and overall survival (OS) for all patients were 3 (range 5 days–14 months) and 12 months (range 5 days–58 months), respectively. Leptomeningeal disease was reported in 5 (9.6%) cases.

Conclusion

SCA directly followed by GKRS is an effective and time-efficient treatment for large cystic BM in selected patients in which surgery is contraindicated and those with deeply located lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bernstein M, Parrent AG (1994) Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81:165–168. https://doi.org/10.3171/jns.1994.81.2.0165

    Article  CAS  PubMed  Google Scholar 

  2. Franzin A, Vimercati A, Picozzi P, Serra C, Snider S, Gioia L, Ferrari da Passano C, Bolognesi A, Giovanelli M (2008) Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis. J Neurosurg 109:259–267. https://doi.org/10.3171/jns/2008/109/8/0259

    Article  PubMed  Google Scholar 

  3. Higuchi F, Kawamoto S, Abe Y, Kim P, Ueki K (2012) Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component. J Neurosurg 117(Suppl):17–22. https://doi.org/10.3171/2012.7.gks121001

    Article  PubMed  Google Scholar 

  4. Ikushima H, Tokuuye K, Sumi M, Kagami Y, Murayama S, Ikeda H, Tanaka M, Oyama H, Shibui S, Nomura K (2000) Fractionated stereotactic radiotherapy of brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 48:1389–1393. https://doi.org/10.1016/s0360-3016(00)00804-x

    Article  CAS  PubMed  Google Scholar 

  5. Jung TY, Kim IY, Jung S, Jang WY, Moon KS, Park SJ, Lim SH (2014) Alternative treatment of stereotactic cyst aspiration and radiosurgery for cystic brain metastases. Stereotact Funct Neurosurg 92:234–241. https://doi.org/10.1159/000362935

    Article  PubMed  Google Scholar 

  6. Kalkanis SN, Kondziolka D, Gaspar LE, Burri SH, Asher AL, Cobbs CS, Ammirati M, Robinson PD, Andrews DW, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Linskey ME (2010) The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neuro-Oncol 96:33–43. https://doi.org/10.1007/s11060-009-0061-8

    Article  Google Scholar 

  7. Karlsson B, Ericson K, Kihlstrom L, Grane P (1997) Tumor seeding following stereotactic biopsy of brain metastases. Report of two cases. J Neurosurg 87:327–330. https://doi.org/10.3171/jns.1997.87.2.0327

    Article  CAS  PubMed  Google Scholar 

  8. Linskey ME, Andrews DW, Asher AL, Burri SH, Kondziolka D, Robinson PD, Ammirati M, Cobbs CS, Gaspar LE, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Kalkanis SN (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neuro-Oncol 96:45–68. https://doi.org/10.1007/s11060-009-0073-4

    Article  Google Scholar 

  9. Liu X, Yu Q, Zhang Z, Zhang Y, Li Y, Liu D, Jia Q, Zheng L, Xu D (2012) Same-day stereotactic aspiration and Gamma Knife surgery for cystic intracranial tumors. J Neurosurg 117(Suppl):45–48. https://doi.org/10.3171/2012.7.gks121019

    Article  PubMed  Google Scholar 

  10. Lunsford LD, Martinez AJ (1984) Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22:222–230

    Article  CAS  Google Scholar 

  11. Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neuro-Oncol 87:299–307. https://doi.org/10.1007/s11060-007-9510-4

    Article  Google Scholar 

  12. Nakazaki K, Nishigaki M (2018) Evaluation of new lesions and symptoms after gamma knife radiosurgery for brain metastases: a retrospective cohort study. Acta Neurochir 160:1461–1471. https://doi.org/10.1007/s00701-018-3524-x

    Article  PubMed  Google Scholar 

  13. Niranjan A, Witham T, Kondziolka D, Lunsford LD (2000) The role of stereotactic cyst aspiration for glial and metastatic brain tumors. Can J Neurol Sci 27:229–235

    Article  CAS  Google Scholar 

  14. Pan HC, Sheehan J, Stroila M, Steiner M, Steiner L (2005) Gamma knife surgery for brain metastases from lung cancer. J Neurosurg 102(Suppl):128–133

    Article  Google Scholar 

  15. Park WH, Jang IS, Kim CJ, Kwon DH (2009) Gamma knife radiosurgery after stereotactic aspiration for large cystic brain metastases. J Korean Neurosurg Soc 46:360–364. https://doi.org/10.3340/jkns.2009.46.4.360

    Article  PubMed  PubMed Central  Google Scholar 

  16. Patchell RA (2003) The management of brain metastases. Cancer Treat Rev 29:533–540

    Article  Google Scholar 

  17. Patchell RA, Regine WF (2003) The rationale for adjuvant whole brain radiation therapy with radiosurgery in the treatment of single brain metastases. Technol Cancer Res Treat 2:111–115

    Article  Google Scholar 

  18. Tendulkar RD, Liu SW, Barnett GH, Vogelbaum MA, Toms SA, Jin T, Suh JH (2006) RPA classification has prognostic significance for surgically resected single brain metastasis. Int J Radiat Oncol Biol Phys 66:810–817. https://doi.org/10.1016/j.ijrobp.2006.06.003

    Article  PubMed  Google Scholar 

  19. Wang H, Qi S, Dou C, Ju H, He Z, Ma Q (2016) Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases. Oncol Lett 12:343–347. https://doi.org/10.3892/ol.2016.4603

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Yamanaka Y, Shuto T, Kato Y, Okada T, Inomori S, Fujino H, Nagano H (2006) Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors. J Neurosurg 105(Suppl):79–81. https://doi.org/10.3171/sup.2006.105.7.79

    Article  PubMed  Google Scholar 

  21. Yoshida S, Morii K (2004) The role of surgery in the treatment of brain metastasis: a retrospective review. Acta Neurochir 146:767–770. https://doi.org/10.1007/s00701-004-0228-1

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gamma Knife Center, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Zjiwar H. A. Sadik, Patrick E. J. Hanssens, Jeroen B. Verheul, Suan Te Lie, Bram van der Pol & Guus N. Beute

  2. Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Zjiwar H. A. Sadik, Jeroen B. Verheul, Hilko Ardon, Suan Te Lie, Bram van der Pol & Guus N. Beute

  3. Department of Neurosurgery, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Zjiwar H. A. Sadik & Sieger Leenstra

  4. Department of Pathology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Ruth E. M. Fleischeuer

Authors
  1. Zjiwar H. A. Sadik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick E. J. Hanssens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeroen B. Verheul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hilko Ardon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suan Te Lie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bram van der Pol
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guus N. Beute
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ruth E. M. Fleischeuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sieger Leenstra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zjiwar H. A. Sadik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Portions of this work were presented as an oral presentation at the 18th Leksell Gamma Knife Society Meeting, Amsterdam, The Netherlands, May 15–19, 2016.

This article is part of the Topical Collection on Brain Tumors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadik, Z.H.A., Hanssens, P.E.J., Verheul, J.B. et al. Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases. Acta Neurochir 163, 343–350 (2021). https://doi.org/10.1007/s00701-020-04273-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04273-1

Keywords

Search

Navigation