scholarly journals Commentary: The Effects of Postoperative Neurological Deficits on Survival in Patients With Single Brain Metastasis

2020 ◽  
Author(s):  
Michael Zhang ◽  
Gordon Li
Keyword(s):  
Brain Metastasis ◽  
Neurological Deficits ◽  
Single Brain Metastasis

scholarly journals The Effects of Postoperative Neurological Deficits on Survival in Patients With Single Brain Metastasis

2020 ◽  
Author(s):  
Ravi Medikonda ◽  
Christopher M Jackson ◽  
James Feghali ◽  
Michael Lim
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Surgical Resection ◽  
Median Overall Survival ◽  
Standard Of Care ◽  
Neurological Deficits ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Single Brain Metastasis ◽  
Postoperative Deficit

Abstract BACKGROUND The prognosis for brain metastasis is poor, and surgical resection is part of the standard of care for these patients as it has been shown to improve median overall survival. Development of neurological deficits after surgical resection has been associated with worsened outcomes in patients with glioblastoma. The effect of postoperative neurological deficits on survival in patients with single brain metastasis has not been studied to date. OBJECTIVE To evaluate the association between postoperative neurological deficits and median overall survival. METHODS A single-institution retrospective cohort study was performed on all patients with single brain metastasis undergoing surgical resection by a single neurosurgeon. RESULTS A total of 121 patients met the inclusion criteria for this study. Among them 61% of patients presented with a preoperative deficit, and 26% of patients had a new postoperative deficit. However, most postoperative deficits resolved and only 3.3% of patients developed a new permanent postoperative deficit. Median overall survival in patients with a new postoperative deficit was 2.4 mo, whereas mOS in patients without a postoperative deficit was 12.6 mo (P < .0001). CONCLUSION This study suggests that a new neurological deficit is associated with worsened outcomes after surgical resection of a single brain metastasis. This finding has potential implications for patient selection and counseling as the patients most likely to benefit from surgical resection are the patients who are most likely to have resolution of a preoperative deficit.

Gamma Knife surgery for multiple brain metastases from a malignant schwannoma of the penis

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 238-240 ◽  
Author(s):  
Albertus T. C. J. van Eck ◽  
Gerhard A. Horstmann
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
De Novo ◽  
Tumor Resection ◽  
Gamma Knife Surgery ◽  
Malignant Schwannoma ◽  
Efficacy And Safety ◽  
Single Brain Metastasis ◽  
Therapy Option

✓The occurrence of brain metastases from a malignant schwannoma of the penis is extremely rare. In patients with a single brain metastasis, microsurgical extirpation is the treatment of choice and verifies the diagnosis. In cases of multiple or recurrent metastases, radiosurgery is an effective and safe therapy option. Gamma Knife surgery was performed in a patient who had previously undergone tumor resection and who presented with recurrence of the lesion and three de novo brain metastases. This first report on brain metastasis from a malignant penile schwannoma illustrates the efficacy and safety of radiosurgical treatment for these tumors.

Treatment of a Single Brain Metastasis

JAMA ◽  
1998 ◽  
Vol 280 (17) ◽  
Author(s):  
Arlan Pinzer Mintz ◽  
J. Gregory Cairncross
Keyword(s):  
Brain Metastasis ◽  
Single Brain Metastasis

scholarly journals Practice parameters for the management of single brain metastasis

2000 ◽  
Vol 9 (6) ◽  
pp. 1-9 ◽  
Author(s):  
Jack P. Rock ◽  
Stephen Haines ◽  
Lawrence Recht ◽  
Mark Bernstein ◽  
Raymond Sawaya ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
American Association ◽  
Management Strategies ◽  
Brain Lesion ◽  
Standards Of Care ◽  
Evidence Based ◽  
Optimal Management ◽  
Practice Parameters ◽  
Single Brain Metastasis ◽  
A Charge

Object In January 1998 the Guidelines and Outcomes Committee of the American Association of Neurological Surgeons (AANS) issued a charge for the development of evidence-based practice parameters focusing on the treatment of patients with single metastasis to the brain. The charge was imposed in response to the significant controversy surrounding questions relating to the optimal management strategies for patients with single brain metastasis. Methods A team consisting of physicians from the AANS, the American Academy of Neurology, and the American Association of Therapeutic Radiation Oncology convened and the literature was reviewed. Methodically drawing from the best of Class I, II, and III levels of available evidence, authors sought to determine how the literature addressed and disposed of the question of the optimal management for an adult with a known history of cancer and a single meta-static brain lesion. Framing the question in this specific manner allowed researchers to focus directly on treatment issues, without having to consider diagnostic issues. Conclusions The results of the evidence-based analysis demonstrated that there was insufficient information to establish standards of care. Data from the literature does, however, support a guideline stating that surgical resection accompanied by whole brain radiation therapy is associated with the best survival rate. Additional lower-quality evidence supports an option for management with radiosurgery.

Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

2013 ◽  
Vol 119 (6) ◽  
pp. 1395-1400 ◽  
Author(s):  
Jens Gempt ◽  
Julia Gerhardt ◽  
Vivien Toth ◽  
Stefanie Hüttinger ◽  
Yu-Mi Ryang ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Neurological Deficit ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Brain Irradiation ◽  
Diffusion Weighted ◽  
The Mean

Object Brain metastases occur in 10% to 40% of patients harboring cancer. In cases of neurosurgical metastasis resection, all postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage due to resection, hemorrhage, venous congestive infarcts, or arterial ischemic events leading to tissue infarction. The aim of this study was to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastasis and to determine their influence on new postoperative neurological deficits. Methods Patients who underwent resection of brain metastases and had preoperative and early postoperative (within 48 hours) MRI scans, including diffusion-weighted imaging sequences and apparent diffusion coefficient maps, between January 2009 and May 2012 were included in this study. Clinical and histopathological data (histopathological results, pre- and postoperative neurological status, and previous tumor-specific therapy) were recorded. Results One hundred twenty-two patients (56 male, 66 female) who underwent resection of brain metastases were included. The patients' mean age was 60 years (range 21–89 years). The mean time span from initial tumor diagnosis to resection of brain metastasis was 44 months (range 0–338 months). The mean preoperative Karnofsky Performance Status was 80% (exact mean 76% ± 17% [SD]), and the mean postoperative value was 80% (exact mean 78% ± 17%). Twelve (9.8%) of the 122 patients had postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit; 44 (36.1%) of the 122 patients had postoperative ischemic lesions. When comparing patients with and without previous brain irradiation, 53.8% of patients with previous brain irradiation had ischemic lesions on postoperative imaging compared with 31.3% of patients without previous brain irradiation (p = 0.033). There was a significant association between ischemia and postoperative neurological status deterioration (transient or permanent); 13 (29.5%) of 44 patients with ischemic lesions had deterioration of their neurological status compared with 7 (9%) of the 78 patients who did not have ischemic lesions (p = 0.003). Conclusions This study demonstrates a high prevalence of vascular incidents in patients undergoing resection for metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological deficits (transient or permanent). Patients who had previous irradiation therapy are at higher risk of developing postoperative ischemic lesions. A large number of postoperative neurological deficits are caused by ischemic incidents.

scholarly journals Texture analysis on diffusion tensor imaging: discriminating glioblastoma from single brain metastasis

2018 ◽  
Vol 60 (3) ◽  
pp. 356-366 ◽  
Author(s):  
Karoline Skogen ◽  
Anselm Schulz ◽  
Eirik Helseth ◽  
Balaji Ganeshan ◽  
Johann Baptist Dormagen ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Brain Metastasis ◽  
Diagnostic Accuracy ◽  
Texture Analysis ◽  
Diffusion Tensor ◽  
Statistical Parameter ◽  
Postoperative Management ◽  
Peritumoral Edema ◽  
Significant Difference ◽  
Single Brain Metastasis

Background Texture analysis has been done on several radiological modalities to stage, differentiate, and predict prognosis in many oncologic tumors. Purpose To determine the diagnostic accuracy of discriminating glioblastoma (GBM) from single brain metastasis (MET) by assessing the heterogeneity of both the solid tumor and the peritumoral edema with magnetic resonance imaging (MRI) texture analysis (MRTA). Material and Methods Preoperative MRI examinations done on a 3-T scanner of 43 patients were included: 22 GBM and 21 MET. MRTA was performed on diffusion tensor imaging (DTI) in a representative region of interest (ROI). The MRTA was assessed using a commercially available research software program (TexRAD) which applies a filtration histogram technique for characterizing tumor and peritumoral heterogeneity. The filtration step selectively filters and extracts texture features at different anatomical scales varying from 2 mm (fine) to 6 mm (coarse). Heterogeneity quantification was obtained by the statistical parameter entropy. A threshold value to differentiate GBM from MET with sensitivity and specificity was calculated by receiver operating characteristic (ROC) analysis. Results Quantifying the heterogeneity of the solid part of the tumor showed no significant difference between GBM and MET. However, the heterogeneity of the GBMs peritumoral edema was significantly higher than the edema surrounding MET, differentiating them with a sensitivity of 80% and specificity of 90%. Conclusion Assessing the peritumoral heterogeneity can increase the radiological diagnostic accuracy when discriminating GBM and MET. This will facilitate the medical staging and optimize the planning for surgical resection of the tumor and postoperative management.

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