Delattre J Y, Krol G, Thaler H T, Posner J B
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Arch Neurol. 1988 Jul;45(7):741-4. doi: 10.1001/archneur.1988.00520310047016.
The number and site of brain metastases were identified on the computed tomographic scans of 288 patients. There was one brain metastasis in 49%, two in 21%, three in 13%, four in 6%, and five or more in 11% of scans. In patients with one metastasis, the posterior fossa was involved in 50% of patients when the primary tumor was pelvic (prostate or uterus) or gastrointestinal, but it was involved in only 10% of patients with other primary tumors. Hemispheral metastases preferred the anatomic "watershed areas" (29% of the brain surface contained 37% of the metastases), indicating that tumoral microemboli tend to lodge in the capillaries of the distal parts of the superficial arteries. The charts of 134 patients with brain metastases from a primary tumor originating outside the lung revealed that the incidence of lung and spine metastases was the same, whether the primary tumor was pelvic or gastrointestinal or from another site. These data suggest that the high incidence of subtentorial lesions in patients with pelvic and gastrointestinal primary tumors cannot be explained by arterial embolization alone, and that this peculiar distribution is probably not explained by seeding of the brain through Batson's plexus.
通过对288例患者的计算机断层扫描确定脑转移瘤的数量和部位。扫描结果显示，49%的患者有1个脑转移瘤，21%有2个，13%有3个，6%有4个，11%有5个或更多。在有1个转移瘤的患者中，当原发肿瘤为盆腔（前列腺或子宫）或胃肠道肿瘤时，50%的患者后颅窝受累，但其他原发肿瘤患者中只有10%后颅窝受累。半球转移瘤更倾向于位于解剖学上的“分水岭区域”（脑表面的29%含有37%的转移瘤），这表明肿瘤微栓子倾向于滞留在浅表动脉远端的毛细血管中。134例原发肿瘤位于肺外的脑转移瘤患者的病历显示，无论原发肿瘤是盆腔、胃肠道还是其他部位，肺和脊柱转移的发生率相同。这些数据表明，盆腔和胃肠道原发肿瘤患者幕下病变的高发生率不能仅用动脉栓塞来解释，这种特殊的分布可能也不是通过Batson静脉丛向脑内播散来解释的。
