Introduction: Cerebral metastases are the most common brain tumor. Almost 30% of cancer patients develop cerebral metastases. More than 50% of patients harbor multiple lesions.
Methods: A retrospective review was conducted on 21 patients affected by multiple brain metastases that were referred to our department. Indications for surgery were: a) Karnofsky performance status (KPS) > 70. b) Unknown or controlled primary tumor. c) Age < 75. Out of 21 patients, 12 underwent surgery, while 9 were found not suitable for surgery. Three patients were harboring lesions of unknown origin. The number of lesions per case in patients that were operated were as follows: 2 in seven cases, 3 in three cases, 4 in one case and 5 in one case. The primary aim of surgery was to remove in a single procedure lesions causing symptoms and/or too big to be treated by other modalities. In all procedures neuronavigation was used.
Results: Surgery was uneventful for all 12 patients. Pathological examination confirmed metastases in all cases and revealed the primary disease in the three patients with unknown primary tumor (2 melanomas and 1 lung cancer). The patient harbouring 5 lesions was actually affected by two metastases and three meningiomas; she was the only patient affected also by non metastatic disease. Mean hospitalisation after surgery was 4 days. All patients were able to begin further treatment at the time indicated by the referring oncologist.
Conclusions: Patients affected by multiple brain metastases in good neurological conditions with unknown or controlled primary disease, even if thought not suitable for surgery due to lesions number or localization, should be referred to the neurosurgeon for evaluation. Single stage image-guided surgery for these patients is often feasible and safe. This allows patients to have occupying space lesions removed, to alleviate/cure symptoms and to begin further treatment as soon as possible.
Patient Care: Not infrequently patients harboring multiple brain metastases are denied surgery. We suggest a neurosurgical evaluation for each case in order to allow selected patients to have multiple lesions removed, improve symptoms and begin adjuvant treatments
Learning Objectives: By the conclusion of this session, participants should be able to: 1. Identify patients cadidate for surgery; 2. Pre-plan surgery with neuronavigation system