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Surgery of brain metastases – Is there still a place for it?

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Summary

The role of surgery in the treatment of metastatic brain tumors has always been a source of controversy. It was only in the early 1990s that two randomized prospective trials demonstrated that surgery plus radiation therapy improved survival in patients with single metastatic brain tumors vs. radiation therapy alone. This paper reviews these articles as well as other evidence outlining management options for multiple brain metastases. An attempt has been made to better define the role of surgery in brain metastases. The prognostic factors for brain metastases after surgery are also reviewed and the data comparing stereotactic radiosurgery to surgery is examined. A short description of surgical planning, operative techniques and tools, followed by a discussion on complication avoidance before, during, and after surgery is included.

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References

  1. D Kondziolka LD Lunsford (1993) Brain metastases MLJ Apuzzo (Eds) Brain surgery: Complication avoidance and management Churchill Livingstone New York 615–641

    Google Scholar 

  2. MD. Simionescu (1960) ArticleTitleMetastatic tumors of the brain: a follow-up study of 195 patients with neurosurgical considerations J Neurosurg 17 361–73 Occurrence Handle14446844

    PubMed  Google Scholar 

  3. JG Cairncross JB Posner (1983) The management of brain metastases MD Walker (Eds) Oncology of the Nervous System Nijhoff Boston 341–377

    Google Scholar 

  4. L Bender JB Posner (1998) Current treatment of brain metastases RJ Maciunas (Eds) Advanced Techniques in Central Nervous System Metastases. Thieme NY 1–16

    Google Scholar 

  5. RA Patchell PA Tibbs JW Walsh RJ Dempsey Y Maruyama RJ Kryscio WR Markesbery JS Macdonald B. Young (1990) ArticleTitleA randomized trial of surgery in the treatment of single metastases to the brain New Eng Med 322 494–500

    Google Scholar 

  6. CJ Vecht H Haaxma-Reiche EM Noordijk GW Padberg JH Voormolen FH Hoekstra JT Tans N Lambooij JA Metsaars AR. Wattendorff (1993) ArticleTitleTreatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33 583–590 Occurrence Handle10.1002/ana.410330605 Occurrence Handle8498838

    Article  PubMed  Google Scholar 

  7. AH Mintz J Kestle MP Rathbone L Gaspar H Hugenholtz B Fisher G Duncan P Skingley G Foster M. Levine (1996) ArticleTitleA randomized trial to assess the efficacy of surgery in addition to radiation therapy in patients with a single metastasis Cancer 78 470–6 Occurrence Handle10.1002/(SICI)1097-0142(19961001)78:7<1470::AID-CNCR14>3.0.CO;2-X

    Article  Google Scholar 

  8. B Young RA Patchell (1995) Brain metastases Youmans (Eds) Neurological Surgery W.B Saunders Philadelphia 2748–2760

    Google Scholar 

  9. R Sawaya M Hammoud BL Ligon (1999) Intraoperative localization of tumor and margins MS Berger CB Wilson (Eds) Textbook of gliomas Saunders Philadelphia

    Google Scholar 

  10. KT White TR Fleming ER. Laws (1981) ArticleTitleSingle metastasis to the brain – Surgical treatment in 122 consecutive patients Mayo Clin Proc 56 424–428 Occurrence Handle7253704

    PubMed  Google Scholar 

  11. RA Patchell PA Tibbs WF Regine RJ Dempsey M Mohiuddin RJ Kryscio WR Markesbury KA Foon B. Young (1998) ArticleTitlePostoperative radiotherapy in the treatment of single metastasis to the brain JAMA 280 IssueID17 1485–1489 Occurrence Handle10.1001/jama.280.17.1485 Occurrence Handle9809728

    Article  PubMed  Google Scholar 

  12. LM DeAngelis LR Mandell T Thaler DW Kimmel JH Galicich Z Fuks JB. Posner (1989) ArticleTitleThe role of postoperative radiotherapy after resection of single brain metastases Neurosurgery 24 798–805 Occurrence Handle2473409

    PubMed  Google Scholar 

  13. LM DeAngelis J Delattre JB. Posner (1989) ArticleTitleRadiation-induced dementia in patients cured of brain metastases Neurology 39 789–796 Occurrence Handle2725874

    PubMed  Google Scholar 

  14. RK Bindal R Sawaya ME Leavens JJ. Lee (1993) ArticleTitleSurgical treatment of multiple brain metastases J Neurosurg 79 210–216 Occurrence Handle8331402

    PubMed  Google Scholar 

  15. MB Hazuka WD Burleston DN Stroud CE Leonard KO Lillehei JJ. Kinzie (1993) ArticleTitleMultiple brain Metastases are associated with poor survival in patients treated with surgery and radiotherapy J Clin Oncol 11 IssueID2 369–373 Occurrence Handle8426215

    PubMed  Google Scholar 

  16. G. Schackert (2003) ArticleTitleSurgery of Brain metastases – Pro and Contra Onkologie 25 480–1 Occurrence Handle10.1159/000067444

    Article  Google Scholar 

  17. RK Bindal R Sawaya ME Leavens KR Hess SH. Taylor (1995) ArticleTitleReoperation for recurrent brain tumors J Neurosurg 83 600–604 Occurrence Handle7674007

    PubMed  Google Scholar 

  18. MC Korinth C Delonge BO Hutter JM. Gilsbach (2002) ArticleTitlePrognostic factors for patients with microsurgically resected brain metastases Onkologie 24 420–425 Occurrence Handle10.1159/000067435

    Article  Google Scholar 

  19. O Agboola BG Benoit P Cross V DaSilva B Esche H. Lesiuk (1998) ArticleTitlePrognostic factors derived from recursive partition analysis (RPA) of radiation therapy oncology group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastases cases Int J Radiat Oncol Biol Phys 42 155–159 Occurrence Handle10.1016/S0360-3016(98)00198-9 Occurrence Handle9747833

    Article  PubMed  Google Scholar 

  20. L Gaspar C Scott M Rotman S Asbell T Phillips T Wasserman WG McKenna R. Byhardt (1997) ArticleTitleRecurssive partition analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastses trials Int J Radiat Oncol Biol Phys 37 745–751 Occurrence Handle10.1016/S0360-3016(96)00619-0 Occurrence Handle9128946

    Article  PubMed  Google Scholar 

  21. JT Sundstrom H Minn KK Lertola E. Nordman (1998) ArticleTitlePrognosis of patients treated for intracranial metastases with whole brain irradiation Ann Med 30 296–299 Occurrence Handle9677016

    PubMed  Google Scholar 

  22. AK Bindal RK Bindal KR Hess A Shiu SJ Hassenbusch WM Shi R. Sawaya (1996) ArticleTitleSurgery vs. radiosurgery in the treatment of brain metastasis J Neurosurg 84 748–754 Occurrence Handle8622147

    PubMed  Google Scholar 

  23. RM Auchter JP Lamond E Alexander JM Buatti R Chappell WA Friedman TJ Kinsella AB Levin WR Noyes CJ Schultz JS Loeffler MP. Mehta (1996) ArticleTitleA multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis Int J Rad Onc Biol Phys 35 IssueID1 27–35 Occurrence Handle10.1016/S0360-3016(96)85008-5

    Article  Google Scholar 

  24. EM Noordjik CJ Vecht H Haaxman-Reiche GW Padberg JHC Voormolen FH Hoekstra JTJ Tans N Lambooij JAL Metsaars AR Wattendorf R Brand J. Hermans (1994) ArticleTitleThe choice of treatment of single brain metastasis should be based on extra-cranial tumor activity and age Int J Rad Onc Biol Phys 29 711–717

    Google Scholar 

  25. BP O’Neill NJ Iturria MJ Likn BE Pollock KV Ballman JR. O’Fallon (2003) ArticleTitleA comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases Int J Rad Onc Biol Phys 55 IssueID5 1169–1176 Occurrence Handle10.1016/S0360-3016(02)04379-1

    Article  Google Scholar 

  26. N Shinoura R Yamada K Okamoto A Nakamura N. Shitara (2002) ArticleTitleLocal recurrence of metastatic brain tumor after stereotactic radiosurgery or surery plus radiation J Neuro-Onc 60 71–77 Occurrence Handle10.1023/A:1020256721761

    Article  Google Scholar 

  27. SD Chang E Lee GT Sakamoto N Brown J. Adler (2000) ArticleTitleStereotactic radiosurgery in patients with multiple brain metastases Neurosurg Focus 9 IssueID2 3

    Google Scholar 

  28. Z Petrovich C Yu SL Giannota S O’Day MLJ. Apuzzo (2002) ArticleTitleSurvival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery J Neurosurg 97 IssueID5 499–506 Occurrence Handle12507085

    PubMed  Google Scholar 

  29. M Gerosa A Nicolato R Foroni B Zanotti M Tomazzoli. Miscusi F Alessandrini A. Bricolo (2002) ArticleTitleGamma knife radiosurgery for brain metastases: a primary therapeutic option J Neurosurg 97 IssueID5 515–524 Occurrence Handle12507088

    PubMed  Google Scholar 

  30. D Kondziolka A Patel LD Lunsford A Kassam JC. Flickinger (1999) ArticleTitleStereotactic radiosurgery plus whole brain radiotherapy vs. radiotherapy alone for patients with multiple brain metastases Int. J. Rad Onc Biol Phys 45 IssueID2 427–434 Occurrence Handle10.1016/S0360-3016(99)00198-4

    Article  Google Scholar 

  31. T Hasegawa D Kondziolka JC Flickinger A Germanwala LD. Lunsford (2003) ArticleTitleBrain metastases treated with radiosurgery alone: an alternateive to whole brain radiotherapy? Neurosurgery 52 IssueID6 1318–1326 Occurrence Handle10.1227/01.NEU.0000064569.18914.DE Occurrence Handle12762877

    Article  PubMed  Google Scholar 

  32. PD Brown CA Brown BE Pollock DA Gorman RL. Foote (2002) ArticleTitleStereotactic radiosurgery for patients with ‘radioresistant’ brain metastases Neurosurgery 51 IssueID3 656–667 Occurrence Handle10.1097/00006123-200209000-00009 Occurrence Handle12188943

    Article  PubMed  Google Scholar 

  33. JC. Ganz (2002) ArticleTitleGamma knife radiosurgery and its possible relationship to malignancy: a review J Neurosurg 97 644–652 Occurrence Handle12507113

    PubMed  Google Scholar 

  34. M. LandyHJ Egnor (1991) ArticleTitleIntraoperative ultrasonography and cortical mapping for removal of deep cerebral tumors South Med J 84 1323–1326 Occurrence Handle1948216

    PubMed  Google Scholar 

  35. CC Wood DD Spencer T Allison G McCarthy PD Williamson WR. Goff (1988) ArticleTitleLocalization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials J Neurosurg 68 99–111 Occurrence Handle3275756

    PubMed  Google Scholar 

  36. GA Grant D Farrell DL. Silbergeld (2002) ArticleTitleContinuous somatosensory evoked potential monitoring during brain tumor resection – report of four cases and review of the literature J Neurosurg 97 709–713 Occurrence Handle12296660

    PubMed  Google Scholar 

  37. PA Forsyth S Weaver D Fulton PMA Brasher G Sutherland D Stewart NA Hagen P Barnes JG Cairncross LM. DeAngelis (2003) ArticleTitleProphylactic anticonvulsants in patients with brain tumor Can J Neurol Sci 30 106–112 Occurrence Handle12774949

    PubMed  Google Scholar 

  38. DA Frim FG Barker CE Poletti AJ. Hamilton (1992) ArticleTitlePostoperative low dose heparin decreases thromboembolic complications in neurosurgery patients Neurosurgery 30 830–833 Occurrence Handle1614582

    PubMed  Google Scholar 

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Correspondence to Philip H. Gutin.

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Modha, A., Shepard, S.R. & Gutin, P.H. Surgery of brain metastases – Is there still a place for it?. J Neurooncol 75, 21–29 (2005). https://doi.org/10.1007/s11060-004-8095-4

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