Artikel
Outcomes after surgical treatment of cerebellar metastases
Behandlungsergebnisse nach Operation cerebellärer Metastasen
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Autoren
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Tunc Faik Ersoy
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Neda Mokhtari
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Matthias Simon
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: To critically review our institutional experience with surgical treatment of cerebellar metastases (CM).
Methods: Pertinent data of 80 consecutive patients who underwent surgery for removal of CM 2015-2020 were analysed retrospectively. Standard statistical methods (SSPS 25, IBM) were employed.
Results: The cohort was 58.8% female. Median age was 61 years. The most frequent primary tumours were lung (48.8%) and breast cancer (26.3%). 38 patients (48.5%) had multiple (2-3: 19, >3: 19) metastases. Neuroimaging revealed obstructive hydrocephalus in 36.3% with clinical signs and symptoms in 20.0%. Four cases required external ventricular drains, and 2 patients a permanent VP shunt.
Median overall survival (medOS) was 9.2 months (GPA 0–1.0, 1.5–2.5, 3.0, 3.5–4.0: 5.1, 9.2, 23.9, 23.3 months; p=0.048). Prominent prognostic factors included single vs. multiple metastases (medOS 14.2 vs. 7.4 months; p=0.028), the preoperative KPI<70 vs. 70-100 (medOS 6.5 vs. 14.2 months; p=0.005) and clinical (but not radiological) hydrocephalus (medOS 6.6 vs. 14.0 months; p=0.009). Age and presence of extracerebral metastases did not significantly influence survival. Prognosis also varied significantly with the degree of resection (resection of all cerebellar and supratentorial disease vs. unresected supratentorial tumour, resection of all cerebellar disease vs. residual cerebellar tumour: 14.2, 7.9, 2.6 months; p=0.011).
The median postoperative KPI was 80 (25-75% IQF: 60-90). Postoperative KPI worsening vs. improvement ≥20 was observed in 9 (11.3%) vs. 7 (8.8%) cases, respectively. 30 days mortality was 5%. Serious (CTCAE grade 3–5) neurological adverse event persisting at discharge were seen in 5/76 cases (6.6%). There were 14 surgical and 7 medical CTCAE grade 3-5 complications.
Conclusion: Survival in this series compares favourably with the literature. Survival after resection of all metastases was comparable to survival after surgery for a single metastasis. Resection of CM only was still associated with reasonable survival. A significant negative prognostic impact was seen for clinical but not radiological hydrocephalus, which favours timely surgery. The presence of extracerebral disease had no prognostic influence suggesting that postponing staging after the metastasectomy is acceptable. Surgery for CM carries a substantial complication rate, however, functional outcomes are not as bad as often thought.
