gms | German Medical Science

Objective: Although complete en-bloc resection of cerebral metastases should be attempted, it is not possible in all patients when metastases are localized in eloquent-brain areas and are adherent to or infiltrate adjacent brain tissue. Therefore, we analyzed the potential impact of awake surgery as a tool to prevent neurological deficits for surgery of cerebral metastases.

Method: A retrospective analysis was performed for all patients, who underwent awake surgery with intraoperative cortical and subcortical stimulation for a cerebral metastasis between May 2009 and June 2012. All metastases were localized in eloquent brain areas, defined as areas in which intraoperative stimulation was expected to elicit motor-, language or sensory response. Pre- and postsurgical neurological status was assessed by the NIH Stroke Scale. Extent of resection was assessed by early postoperative MRI. Permanent deficits were defined by persistence after 3 months observation time.

Results: A total of 34 patients were operated for a cerebral metastases in eloquent brain areas as awake surgery with intraoperative cortical and subcortical stimulation. In 24/34 patients (70.6%), a complete resection of the tumor was achieved. 5/34 patients (14.7%) had a new transient postoperative neurological deficit which improved within a few days due to a supplementary motor area (SMA) syndrome. Permanent deficits were not observed. Median preoperative NIHSS was 1 (range: 0 – 12, standard deviation, SD: 2.6). Median postoperative NIHSS score measured on the first postoperative day was unchanged (range: 0 – 9, SD: 2.4). Postoperative NIHSS scores worsened in 5 patients, improved in 7 patients and were unchanged in 22 patients.

Conclusions: Awake surgery and cortical and subcortical stimulation seems to be a feasible tool for minimizing postoperative neurological deficits and morbidity. However, patients still need to be informed about the high risk of temporary deficits.