Artikel
Multiple craniotomies in a single surgery – the resection of scattered brain metastases
Multiple Kraniotomien in einzeitiger Operation – individualisierte Metastasenchirurgie
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Autoren
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Maximilian Bschorer
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Franz Lennard Ricklefs
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Patients with cerebral metastases, who can benefit from resection of multiple scattered lesions often do not undergo a daring procedure involving multiple craniotomies in one sitting due to the overall poor prognosis of their systemic disease. However, selected patients could benefit from either total resection of all intracranial lesions to relieve neurological symptoms or a greater effectiveness of postoperative radiosurgery.
Methods: In this retrospective analysis, the records of patients, who were treated for multiple metastatic brain lesions using one surgery involving multiple craniotomies, over a span of 60 months (2016 to 2021) were reviewed. Clinical and surgical data such as the preoperative and postoperative Karnofsky Performance Scale (KPS), complication rate, tumor size, number of lesions, number of craniotomies, skin incisions and intraoperative repositioning of patients were recorded.
Results: Thirty-three patients were included in this study (male=12, female=21). The average age was 58.8 ± 12.3 years. Lung cancer was the most common diagnosis (n=12, 36%), while the other patients had breast (n=6, 18%), skin (n=4, 12%), colorectal (n=4, 12%) or other tumor entities (n=7, 22%). 30 patients underwent two craniotomies, while three surgeries involved three craniotomies. Seven patients (21%) were intraoperatively repositioned from a prone to a supine position, which required an average of 23.3 ± 9.3 minutes from wound closure to the following skin incision. The postoperative KPS remained unchanged for 52% of patients (n=17), while improving in 27% (n=9) and declining in 21% (n=7) of cases. Surgical complications included postoperative hemorrhage evacuation (n=2, 6%), surgical site infection (n=2, 6%), one thromboembolic event (n=1, 3%) but no postoperative seizure or in-hospital mortality. The average duration of surgery was 260 ± 96 minutes.
Conclusion: In the age of personalized medicine, selected patients may benefit from a single surgery to remove brain metastases using multiple craniotomies. A structured approach, whether this surgical timing is superior to an approach involving multiple surgeries to achieve the same surgical outcome, is warranted.
