Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases

Abstract

BackgroundWhen treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection.MethodsBetween 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome.ResultsIn general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol.ConclusionsSurgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered.

Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach

“…Yet, there was a statistical trend for a greater extent of the perifocal T2WI lesion in patients with a motor deficit (60.9 Ϯ 34.8 cm 3 ) compared with the others (38.1 Ϯ 27.2, P ϭ .08) (On-line Fig 2A). Cortical M1 representations (3.4 Ϯ 1.1 versus 3.6 Ϯ 0.8 cm 3 ) and the mean CST volumes (0.7 Ϯ 0.3 versus 0.5 Ϯ 0.2 cm 3 ) were of equal size between the 2 groups (P Ͼ .1) (On-line Fig 2B).…”

“…The deterioration of existing or newly developed motor deficits does not only reduces the quality of life but also reduces overall survival of the affected patients independent of the extent of resection and the adjuvant therapy. 3,29 Tumor size, location, and infiltrative growth patterns have been discussed as underlying causes of neurologic impairment in those patients. 5 Here, we found that patients with tumor masses directly within motor functional tissue as depicted by FET-PET or T1-CE merely accounted for approximately half of the patients with motor deficits.…”

“…The corrections for a component-based normalization, attenuation, and scatter, dead-time, and decay were performed within the reconstruction process thereafter. 25 The reconstructed images had 256 ϫ 256 ϫ 153 isotropic voxels of 1.25 mm 3 and were subsequently filtered with a 3D Gaussian kernel (filter width, 3 mm) to increase the SNR.…”

“…2 A frequently encountered phenomenon in patients presenting with tumors in the vicinity of motor regions is that some of them have motor impairment while others do not, and some deteriorate after the operation while others may even improve. [3][4][5] In some patients, motor deficits can be explained by direct infiltration of the tumor into the motor cortex or corticospinal tract (CST), while in other patients, compression effects resulting from the tumor mass and/or perifocal edema may cause motor symptoms. 5 Differentiating causes is, however, highly relevant with respect to the reversibility of symptoms and planning of operations.…”

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

“…According to current guidelines, surgery is recommended for symptomatic and accessible brain metastases followed by whole-brain irradiation or stereotactic irradiation [3 -6]. As surgery is a safe treatment according to a recent study, some risk factors such as location in an eloquent region or preoperative radiotherapy that may increase the risk of postoperative neurological deficits have to be considered preoperatively [7].…”