Stereotactic radiosurgery for metastatic brain tumors: a comprehensive review of complications

Williams, Brian J.; Suki, Dima; Fox, Benjamin D.; Pelloski, Christopher E.; Maldaun, Marcos Vinícius Calfat; Sawaya, Raymond; Lang, Frederick F.; Rao, Ganesh

doi:10.3171/2008.11.jns08984

Cited by 105 publications

(83 citation statements)

References 49 publications

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“…10,15,20,21 The rate of new or aggravated treatmentrelated motor weakness for our series is comparable to some but higher than other series on treatment of stereotactic radiosurgery. 17,35 However, we have to keep in mind that our series only includes patients who were not eligible for radiotherapy according to the current guidelines due to radioresistant tumors or significant mass effects. 2,7,9,16 Thus, this study does not deal with indications for surgery of brain metastases per se but rather with reliability and usefulness of IOM during resection of these lesions.…”

Section: Discussionmentioning

confidence: 99%

Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Krieg¹,

Schäffner²,

Shiban³

et al. 2013

JNS

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F or the treatment of cerebral metastases, indication for surgery is currently limited to a subgroup of patients. Although radiosurgery and resection have been shown to be equivalent in terms of survival, some studies have shown that radiosurgery leads to better local control due to its effect on the infiltration zone surrounding the lesion and whole brain radiation therapy is associated with significantly shorter survival.26,27 Nevertheless, in many patients who have focal deficits resulting from metastases, resection is still undertaken in order to achieve rapid improvement in neurological function. Metastases within or close to the motor cortex or subcortical motor tracts may therefore be treated by resection.Intraoperative neuromonitoring is routinely used for resection of gliomas in or adjacent to the motor system. 15,22,33 Cerebral metastases, however, are generally believed to be noninfiltrative, and IOM during resection of these lesions in motor-eloquent regions is still not widely described. 29 As recent studies have shown that cerebral metastases also infiltrate surrounding brain tissue, intraoperative surveillance of the motor systems might be helpful to reduce surgery-related motor deficits. 25,26,28 Motor evoked potential monitoring allows us to identify crucial steps during resection of tumors within the rolandic region or tumors adjacent to the pyramidal tract. 5,19,21,24,33 Furthermore, several studies have shown that MEP moniReliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions Object. Resection of gliomas in or adjacent to the motor system is widely performed using intraoperative neuromonitoring (IOM). For resection of cerebral metastases in motor-eloquent regions, however, data are sparse and IOM in such cases is not yet widely described. Since recent studies have shown that cerebral metastases infiltrate surrounding brain tissue, this study was undertaken to assess the value and influence of IOM during resection of supratentorial metastases in motor-eloquent regions.Methods. Between 2006 and 2011, the authors resected 206 consecutive supratentorial metastases, including 56 in eloquent motor areas with monitoring of monopolar direct cortically stimulated motor evoked potentials (MEPs). The authors evaluated the relationship between the monitoring data and the course of surgery, clinical data, and postoperative imaging.Results. Motor evoked potential monitoring was successful in 53 cases (93%). Reduction of MEP amplitude correlated better with postoperative outcomes when the threshold for significant amplitude reduction was set at 80% (only > 80% reduction was considered significant decline) than when it was set at 50% (> 50% amplitude reduction was considered significant decline). Evidence of residual tumor was seen on MR images in 28% of the cases with significant MEP reduction. No residual tumor was seen in any case of stable MEP monitoring. Moreover, preoperative motor deficit, recursive parti...

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Section: Discussionmentioning

confidence: 99%

Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Krieg¹,

Schäffner²,

Shiban³

et al. 2013

JNS

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“…AIRS is perhaps the most significant late toxicity associated with SRS, causing neurologic symptoms in up to one third of treated patients [16,18,31,32]. The underlying inflammatory mechanism is thought to result from dysfunctional astrocytes and microglia surrounding the central necrotic zone of the treated lesion [7].…”

Section: Discussionmentioning

confidence: 99%

“…The underlying inflammatory mechanism is thought to result from dysfunctional astrocytes and microglia surrounding the central necrotic zone of the treated lesion [7]. These perinecrotic cells secrete inflammatory cytokines such as VEGF, TNF-α, and ICAM-1, resulting in blood-brain barrier breakdown and angiogenesis; the resultant contrast-enhancing rim apparent on imaging makes it impossible to distinguish from progressive tumor [7,27,[32][33][34]. The resulting edema promotes perilesional hypoxia, driving HIF-1α expression [35] and stimulating a VEGF feedback loop, perpetuating a cycle of edema.…”

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confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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“…Brain tumor is the most common neurological complication related to cancer [39]. Brain tumors can originate from the patient's brain (primary brain tumors) or from other parts of the patient's body (secondary or metastatic brain tumors) [40,41].…”

Section: Overviewmentioning

confidence: 99%

Physical Therapy in Patients with Cancer

Morishita¹,

Tsubaki²

2017

Clinical Physical Therapy

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Physical therapists often treat cancer patients. Cancer treatment includes chemotherapy, radiotherapy, and surgery, which are being continuously developed and thus increase survival of patients with each cancer diagnosis. More speciically, 5-year survival rates increase with each cancer diagnosis. Cancer patients have many problems including muscle weakness, pulmonary dysfunction, fatigue, and pain. In the end, patients with cancer tend to have a decline in activities of daily living (ADL) and quality of life (QOL). Additionally, cancer patients often have progressive disease, depression, and anxiety. Physical therapy often helps patients regain strength and physical function and improve their QOL and independence of daily living that they may have lost due to cancer or its treatment. Physical therapy has an important role in increasing physical function of cancer patients, cancer survivors, and children with cancer. In the future, physical therapy may be progressively needed for management of cancer patients.

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Stereotactic radiosurgery for metastatic brain tumors: a comprehensive review of complications

Abstract: The authors showed that new neurological and nonneurological complications were associated with 40% of SRS treatments for brain metastases. Patients with lesions in functional brain regions have a significantly increased risk of treatment-related complications.

Cited by 105 publications

References 49 publications

Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Physical Therapy in Patients with Cancer

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