Craniectomy Versus Craniotomy for Posterior Fossa Metastases: Complication Profile

Hadanny, Amir; Rozovski, Uri; Nossek, Erez; Shapira, Yuval; Strauss, Ido; Kanner, Andrew A.; Sitt, R.; Ram, Zvi; Shahar, Tal

doi:10.1016/j.wneu.2016.01.076

Cited by 20 publications

(14 citation statements)

References 17 publications

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“…From a general perspective, the management of infratentorial brain metastases has significantly improved over the last decades due to a range of strategic factors including the development of high-performance imaging, safer microsurgical techniques,[ 12 23 28 23 ] advanced intraoperative neurologic monitoring,[ 18 46 ] optimized patient selection, and modern postsurgical care. Microsurgery followed by adjunctive radiotherapy to the surgical site is widely regarded as the ideal upfront management of single large brain metastases.…”

Section: Discussionmentioning

confidence: 99%

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Sinclair¹,

Benmakhlouf²,

Martin³

et al. 2018

Surg Neurol Int

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Background:Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression.Case Descriptions:Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus.Conclusion:For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.

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Section: Discussionmentioning

confidence: 99%

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Sinclair¹,

Benmakhlouf²,

Martin³

et al. 2018

Surg Neurol Int

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“…Posterior fossa surgery traditionally implies use of a craniectomy, in other words: permanent bone removal, without any type of bone replacement; in the last few years however a growing number of surgeons prefer a craniotomy to a craniectomy even in the posterior fossa [1], [2], [3] .The most frequent complications of a craniectomy are pseudomeningoceles, CSF leaks and infections; in the Literature we were not able to find a case like ours of parenchyma herniation through the missing bone flap in the last 20 years.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar hemisphere herniation in the neck: Case report of a very rare complication following a posterior fossa craniectomy

Caruso

Pesce

Piccione³

et al. 2016

International Journal of Surgery Case Reports

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“…If left untreated they will cause hydrocephalus, brainstem compression, and ultimately death. Many patients already present with signs and symptoms of hydrocephalus [ 9 , 10 , 11 , 12 ]. Most posterior fossa metastases are located within the cerebellar hemispheres and vermis.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

Ersoy

Mokhtari

Brainman

et al. 2021

Cancers

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We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI <70% or multiple metastases survived >12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.

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Craniectomy Versus Craniotomy for Posterior Fossa Metastases: Complication Profile

Cited by 20 publications

References 17 publications

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Cerebellar hemisphere herniation in the neck: Case report of a very rare complication following a posterior fossa craniectomy

Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

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