gms | German Medical Science

Objective: For many years there has been a lively discussion about the treatment of patients with brain metastases. Neurosurgeons as well as radiotherapists are able to treat these patients. There is no significant difference in the survival rate of these patients despite the treatment modality. However, no data exists which evaluates the immediate effect of surgery or radiotherapy. The data regarding the quality of life of patients, who are treated because of severe neurological deficits are scarce. In a retrospective study we evaluated the outcome of 178 patients operated in our department on one or multiple intracranial metastases. The aim of the study was to evaluate changes in neurological deficits as well as the quality of life after resection.

Methods: 178 patients with 206 craniotomies were included. The following parameters were collected from the medical charts and correlated using uni- and multivariate methods: age, gender, histology, status of the underlying disease, anatomic location, number and size of the intracranial lesions, peri- and postoperative complications and neurological status pre- and postoperatively. Karnofsky Performance Score (KPS) and Medical Research Council – Neurological Performance Score (MRC-NPS) were used to evaluate the quality of life before and after surgery.

Results: The perioperative mortality was 0%, the morbidity was 10.3%. There was a significant improvement in KPI as well as in MRC-NPS postoperatively (p = 0.001). Especially patients with motor deficits and signs of elevated intracranial pressure (ICP) had an immediate benefit of the surgery (p = 0.014; p = 0.001). Only 4 patients had a new neurological deficit after surgery and 9 patients had intermittent neurological worsening of an existing deficit.

Conclusions: The complication rate of the surgical resection of brain metastases has a lower morbidity rate than radiotherapy (10% vs. 40%, according to the literature). In contrast to patients treated with radiotherapy, the operated patients improved postoperatively immediately which led to a high quality of life. In our opinion, the surgical resection of brain metastases is the therapy of choice and should be discussed in every case.