Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

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Surgical Management Of Posterior Fossa Arteriovenous Malformations

Operative Neurosurgery ◽

10.1227/01.neu.0000204641.38419.2d ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-189-ONS-201 ◽

Cited By ~ 6

Author(s):

John Sinclair ◽

Michael E. Kelly ◽

Gary K. Steinberg

Keyword(s):

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Posterior Fossa ◽

Arteriovenous Malformations ◽

Cranial Nerves ◽

Venous Drainage ◽

Cerebellar Nuclei ◽

Preoperative Embolization ◽

Frameless Stereotaxy ◽

Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

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Stereotactic radiosurgery versus surgical resection for the management of intracranial meningiomas in elderly patients

Acta Neurochirurgica ◽

10.1007/s00701-015-2589-z ◽

2015 ◽

Vol 157 (12) ◽

pp. 2205-2207

Author(s):

Dale Ding

Keyword(s):

Elderly Patients ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Intracranial Meningiomas

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Salvage Surgical Resection After Linac-based Stereotactic Radiosurgery and Radiotherapy for Newly Diagnosed Brain Metastasis

10.21203/rs.3.rs-272644/v1 ◽

2021 ◽

Author(s):

Ryosuke Matsuda ◽

Takayuki Morimoto ◽

Tetsuro Tamamoto ◽

Nobuyoshi Inooka ◽

Tomoko Ochi ◽

...

Keyword(s):

Brain Metastasis ◽

Survival Time ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Cyst Formation ◽

Histopathological Diagnosis ◽

Newly Diagnosed ◽

Long Term Follow Up

Abstract Purpose: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for brain metastasis.Methods: Between November 2009 and December 2018, we treated 427 consecutive patients with 919 lesions with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During the follow-up period, we treated 19 consecutive patients who underwent 21 SSRs for recurrence, radiation necrosis (RN), and cyst formation after SRS/fSRT for newly diagnosed brain metastasis. Two patients underwent multiple surgical resections. Brain metastasis originated from the lung (n=15, 78.9%), breast (n=3, 15.7%), and colon (n=1, 5.2%). Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 15 months (range: 2–76 months). The range of tumor volume at initial SRS/SRT was 0.121–21.459 cm3 (median: 2.188 cm3). Histopathological diagnosis after SSR was recurrence, RN and cyst formation in 13 and 6 cases, respectively. The median survival time from SSR and from initial SRS/SRT was 17 months and 74 months, respectively. The cases with recurrence had a significantly shorter survival time than those without recurrence (p=0.0453).Conclusion: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.

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