gms | German Medical Science

Objective: The current standardized surgical treatment of intracerebral metastases is microsurgical circumferential resection, but adequate local tumor control is known to be difficult and may improve after supramarginal resection. Therefore, we analyzed a series of patients with cerebral metastases in eloquent areas for neurological outcome and tumor control during a 1-year follow-up.

Method: A retrospective analysis was performed for patients, who underwent supramarginal resection as awake surgery with intraoperative cortical and subcortical stimulation, MEPs and SSEPs, for a cerebral metastasis between 03/2009 and 09/2012. Supramarginal resection was achieved by circumferential stripping of the metastasis and additional removal of approximately 3 mm of surrounding tissue. Pre- and postsurgical neurological status was assessed by the NIH Stroke Scale. Permanent deficits were defined by persistence after 3 months observation time.

Results: Supramarginal resection of cerebral metastases in eloquent brain areas was performed in 30 patients with a mean age of 58 years (range 33–83 y). 4/30 patients (13.3%) had a new transient postoperative neurological deficit, which improved within a few days due to a supplementary motor area (SMA) syndrome (median preoperative NIHSS: 2, 0–12, standard deviation, SD: 2.5; median postoperative NIHSS: 2, 0–9, SD: 2.2). 4/30 pts. (13.3%) developed local recurrences and 8 patients (26.6%) distant recurrences. For these patients, the mean progression-free survival was 12 months (range 2–45 m).

Conclusions: Supramarginal resection of cerebral metastases with intraoperative monitoring is a feasible approach for metastases in eloquent areas. Despite aggressive resection, we observed no permanent postoperative neurological deficits. Furthermore, supramarginal resection may achieve a better tumor control as the incidence of local recurrences is lower as compared to the published series. Prospective randomized studies are mandatory in order to analyze the benefit of this method to achieve better local tumor control.