Tan Tze-Ching, McL Black Peter
Department of Neurosurgery, Brigham and Women's Hospital, Department of Surgery, Harvard Medical School, Boston, Massachusetts 02215, USA.
Neurosurgery. 2003 Jul;53(1):82-9; discussion 89-90. doi: 10.1227/01.neu.0000068729.37362.f9.
The purpose of the present study was to analyze the outcomes after craniotomies for brain metastases in a modern series using image-guided technologies either in the regular operating room or in the intraoperative magnetic resonance imaging unit.
Neurosurgical outcomes were analyzed for 49 patients who underwent 55 image-guided craniotomies for excision of brain metastases during a 5-year period. Tumors were located in critical and noncritical function regions of the brain. A total of 23 craniotomies for tumors in critical brain were performed using intravenous sedation anesthesia; craniotomies for noncritical function brain regions were completed under general anesthesia. The patients were also divided into Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classes on the basis of age, Karnofsky Performance Scale scores, state of primary disease, and presence or absence of extracranial metastases.
There was no perioperative mortality. Gross total resection, as verified by postoperative contrast-enhanced computed tomography or magnetic resonance imaging, was achieved in 96% of patients. The median anesthesia time was 4.25 hours, and the median length of hospital stay was 3 days. In 51 symptomatic cases, there was complete resolution of symptoms in 70% (n = 36), improvement in 14% (n = 7), and no change in 12% (n = 6) postoperatively. No patient who was neurologically intact preoperatively deteriorated after surgery, and 93% of patients maintained or improved their functional status. Only two patients (3.6%) with significant preoperative deficits had increased long-term deficits postoperatively. The mean follow-up was 1 year, and the local recurrence rate was 16%. The median survival of the entire group was 16.23 months (17.5 mo in RPA Class I, 22.9 mo in RPA Class II, and 9.8 mo in RPA Class III).
Gross total resection of brain metastases, including those involving critical function areas, can be safely achieved with a low morbidity rate using contemporary image-guided systems. RPA Class I and II patients with controlled primary disease benefit from aggressive treatment by surgery and radiation.
本研究的目的是分析在现代系列中，使用影像引导技术在常规手术室或术中磁共振成像单元进行开颅手术切除脑转移瘤后的结果。
分析了49例患者在5年期间接受55次影像引导下开颅手术切除脑转移瘤的神经外科手术结果。肿瘤位于脑的关键和非关键功能区。对位于脑关键区域的肿瘤进行了23次开颅手术，采用静脉镇静麻醉；对非关键功能脑区的开颅手术在全身麻醉下完成。还根据年龄、卡氏功能状态评分、原发疾病状态以及是否存在颅外转移，将患者分为放射治疗肿瘤学组递归分区分析（RPA）类别。
无围手术期死亡。术后通过对比增强计算机断层扫描或磁共振成像证实，96%的患者实现了肿瘤全切除。中位麻醉时间为4.25小时，中位住院时间为3天。在51例有症状的病例中，术后70%（n = 36）症状完全缓解，14%（n = 7）症状改善，12%（n = 6）症状无变化。术前神经功能正常的患者术后均未恶化，93%的患者功能状态维持或改善。只有两名术前有明显缺陷的患者（3.6%）术后长期缺陷增加。平均随访1年，局部复发率为16%。整个组的中位生存期为16.23个月（RPA I类为17.5个月，RPA II类为22.9个月，RPA III类为9.8个月）。
使用当代影像引导系统，可以安全地实现脑转移瘤的全切除，包括那些累及关键功能区的转移瘤，且发病率低。原发疾病得到控制的RPA I类和II类患者可从手术和放疗的积极治疗中获益。
