gms | German Medical Science

Objective: Several studies reported a considerable risk of new postoperative motor deficits following resection of brain metastases. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) may alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. These situations were repeatedly considered risk factors for perioperative complications. We thus designed this study to identify risk factors for brain metastases resection.

Method: Between 2006 and 2011, we resected 206 consecutive brain metastases, 56 in motor eloquent areas and 150 in non-eloquent ones. We evaluated the influences of preoperative deficit, prior Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome.

Results: Overall 8.7% (n=18) of all 206 patients 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 in the eloquent group (p=0.012) and in the non-eloquent group (p = 0.045). This risk was even higher in perirolandic and rolandic lesions. Our data show a significantly increased risk of new deficits for patients (n=41) assigned to RPA class 3 (p<0.05). Even in non-eloquently located brain metastases the risk of new postoperative paresis should not to be underestimated (7.0%). Additionally, our cohort shows a high rate of unexpected residual tumors in postoperative MRI (21.9%), which supports recent data on brain metastases’ infiltrative nature, but might also reflect our strict postoperative imaging protocol.

Conclusions: 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. Patients should be counseled accordingly.