gms | German Medical Science

Objective: Brain metastases occur in 10% to 40% of patients with cancer. In cases where resection of neurosurgical metastases is performed, any postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage by surgical resection, hemorrhage, venous congestive infarcts or arterial ischemic events leading to tissue infarction. The aim of this study is to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastases and their influence on new postoperative neurological deficits.

Method: Between January 2009 and May 2012 patients, who underwent a surgical resection of brain metastases and had pre- and early postoperative (within 48 hours) MRI scans including DWI sequences and ADC maps were included. The clinical and histopathological data (histopathologica results, pre- and postoperative neurological status and previous tumor-specific therapy) were recorded.

Results: 122 patients, who underwent surgical resection of brain metastases were included. 56 were male and 66 female. Mean patient age was 60 years (21 to 89 years). Mean time span from initial tumor diagnosis to resection of brain metastasis was 44.3 months (0 to 337.6 months). Mean preoperative Karnofsky performance status was 80% (exact mean 76.12, ± 16.646), mean postoperative value was 80% (exact mean 76.88, ± 16.77). 12 of the 122 patients (9.8%) had a postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit. 44 of 122 patients had postoperative ischemic lesions (36.1%). Comparing patients with and without previous brain irradiation 53.8% of patients with previous brain irradiation had ischemic lesions compared to 31.25% of patients without previous brain irradiation (p=0.033). When comparing patients with postoperative neurological status deterioration (transient and permanent) the rate is 9% in the patient group without ischemia (7 of 78 patients) compared to 29.5% of patients with neurological status detoriation (13 of 44 patients) (p=0.003).

Conclusions: In this study we demonstrate a high prevalence of vascular incidents in cancer patients undergoing surgical resection of metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological transient and permanent deficits. Patients who underwent previous irradiation therapy are at higher risk of developing a postoperative ischemic lesion. A definite part of postoperative neurological deficits are caused by ischemic incidents.