Surgical treatment of cerebellar metastases

Abstract

Background:Cerebral metastases are a common neurosurgical finding. Surgery confers several advantages to other therapies, including immediate symptomatic improvement, diagnosis, and relief from corticosteroid dependence. Here we evaluate patients with cerebellar metastases who underwent surgery and compare their findings to those in the literature, and address the benefit of avoiding ventriculo-peritoneal shunting in patients undergoing surgery.Methods:We performed a retrospective analysis involving 50 patients with cerebellar metastases who underwent surgical resection. Ventriculo-peritoneal shunts were placed in patients necessitating permanent CSF drainage. We evaluated presentation, diagnosis, complications, and outcome.Results:Our review included 21 males and 29 females, 29 to 82 years of age. Primary tumors included lung (48%), breast (14%), GI (14%), endometrial/ovarian (6%), melanoma (6%), sarcoma (4%), lymphoma (4%), laryngeal (2%), and other (2%). Clinical symptoms at presentation commonly were those secondary to elevated intracranial pressure and were the initial complaint in 34% of patients. Preoperatively, 29 patients were noted to have hydrocephalus. Importantly, 76% of these patients were able to avoid placement of a ventriculo-peritoneal shunt following surgery. Only two complications were noted in our series of 50 patients, including a symptomatic pseudomeningocele and a wound infection. No symptomatic postoperative hematoma developed in any surgical case.Conclusion:A review of the literature has shown a high complication rate in patients undergoing surgical resection of cerebellar metastases. We have shown that surgical resection of cerebellar metastases is a safe procedure and is effective in the treatment of hydrocephalus in the majority of patients harboring cerebellar lesions.

Are melanomas averse to cerebellum? Cerebellar metastases in a surgical series

“…An apparent aversion of melanomas to metastasize to cerebellum can be observed in former published series, but has to the authors' best knowledge not been explicitly pointed out previously. In series exclusively reporting on cerebellar metastasis, melanomas have accounted for 2.3–10% . In series reporting exclusively on melanoma metastases but addressing different treatment modalities, cerebellar lesions were found in 5.3–9.6% of the patients .…”

“…The following variables are addressed: age, sex, primary tumor location and histology, known primary tumor at surgery (yes/no), synchronous vs metachronous presentation, number of brain metastases, extracranial metastases (yes/no), systemic disease control (controlled/uncontrolled), Karnofsky performance score (KPS) (≥70 vs <70) , recursive partitioning analysis (RPA) status , whole brain radiation therapy (WBRT), local radiation therapy (RT), and stereotactic radiosurgery (SRS). Synchronous presentation was defined as cerebellar metastases encountered within 2 months of primary tumor diagnosis .…”

“…In general, infratentorial tumors are considered more life threatening than supratentorial ones, as tumors in the confined space of the posterior fossa can result in hydrocephalus, brainstem compression, and tonsillar herniation . Gradual onset headache, nausea, and gait instability are the most common presenting symptoms, but some patients might deteriorate rapidly, requiring immediate neurosurgery to prevent a neurological cause of death . However, a literature review provides only few studies addressing the outcome of cerebellar metastases separate from the more common supratentorial lesions .…”

Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients

“…11,12 The incidence of metastatic brain tumors is higher in the elderly population and in Caucasians, and no sex difference has been found. 4 A similar distribution was observed for the development of hydrocephalus in these patients.…”

Epidemiologia das neoplasias intracranianas no Hospital do Servidor Público Estadual de São Paulo: 2010-2012

“…34,50 As metástases para o cerebelo possuem um prognóstico pior em comparação com metástases supratentoriais, em virtude da maior propensão de essas lesões causarem hidrocefalia, hérnia, compressão do tronco cerebral e morte. 51…”