Obermueller Thomas, Schaeffner Michael, Gerhardt Julia, Meyer Bernhard, Ringel Florian, Krieg Sandro M
Department of Neurosurgery, Technische Universität München, Ismaninger Str, 22, 81675 Munich, Germany.
BMC Cancer. 2014 Jan 14;14:21. doi: 10.1186/1471-2407-14-21.
When 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.
Between 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.
In 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.
Surgical 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.
在治疗脑转移瘤时，所有涉及的多学科肿瘤专家必须密切合作，为这些患者提供最佳治疗。对于脑转移瘤切除术，多项研究报告了术后新出现轻瘫的相当大风险。术前和围手术期化疗（Ctx）或放疗（Rtx）一方面会改变血管和相邻纤维束，另一方面许多患者在手术前就已经存在轻瘫。由于这些因素一再被认为是围手术期并发症的危险因素，我们设计了这项研究以确定脑转移瘤切除术的危险因素。
在2006年至2011年期间，我们连续切除了206个脑转移瘤，其中56个位于明确的运动区，150个位于非明确运动区。我们评估了术前轻瘫、先前的Rtx或Ctx以及递归分区分析（RPA）分级对术后结果的影响。
总体而言，所有患者中有8.7%术后出现新的永久性轻瘫。与术前Ctx不同，先前的Rtx作为单一或联合治疗策略是术后运动无力的重要危险因素。在中央前回周围和中央回病变中，这种风险甚至更高。我们的数据显示，被分配到RPA 3级的患者出现新缺陷的风险显著增加。即使在非明确位置的脑转移瘤中，术后新出现轻瘫的风险也不可低估。尽管采用了显微手术方法，但我们的队列在术后MRI中显示出意外残留肿瘤的高发生率，这支持了最近关于脑转移瘤浸润性质的数据，但也可能是我们严格研究方案的结果。
手术切除是治疗脑转移瘤的一种安全方法。然而，在考虑手术切除时，必须考虑术前Rtx和RPA评分3。
