Posterior Fossa Metastasis–Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery

Roux, Alexandre; Botella, Céline; Still, Megan; Zanello, Marc; Dhermain, Frédéric; Métellus, Philippe; Pallud, Johan

doi:10.1016/j.wneu.2018.06.084

Cited by 20 publications

(21 citation statements)

References 65 publications

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“…In addition to the possibility of hydrocephalus or compromise of core structures, the localization of a BM in the posterior fossa is often associated with dysphagia ( 15 , 16 ). The impaired swallowing function with the risk of aspiration contributes to a possible worsening both immediately postoperatively as well as during further treatment ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Outcome of Elderly Patients With Surgically Treated Brain Metastases

et al. 2021

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ObjectIn the light of an aging population and ongoing advances in cancer control, the optimal management in geriatric patients with brain metastases (BM) poses an increasing challenge, especially due to the scarce data available. We therefore analyzed our institutional data with regard to factors influencing overall survival (OS) in geriatric patients with BM.MethodsBetween 2013 and 2018, patients aged ≥ 65 years with surgically treated BM were included in this retrospective analysis. In search of preoperatively identifiable risk factors for poor OS, in addition to the underlying cancer, the preoperative frailty of patients was analyzed using the modified Frailty Index (mFI).ResultsA total of 180 geriatric patients with surgically treated BM were identified. Geriatric patients categorized as least-frail achieved a median OS of 18 months, whereas frailest patients achieved an OS of only 3 months (p<0.0001). Multivariable cox regression analysis detected “multiple intracranial metastases” (p=0.001), “infratentorial localization” (p=0.011), “preoperative CRP >5 mg/l” (p=0.01) and “frailest patients (mFI ≥ 0.27)” (p=0.002) as predictors for reduced OS in older patients undergoing surgical treatment for BM.ConclusionsIn this retrospective series, pre-operative frailty was associated with poor survival in elderly patients with BM requiring surgery. Our analyses warrant thorough counselling and support of affected elderly patients and their families.

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Section: Discussionmentioning

confidence: 99%

Outcome of Elderly Patients With Surgically Treated Brain Metastases

et al. 2021

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“…Surgical management of metastases accounts for an important and increasing part of the neurosurgical workload. Treatment of patients with cerebellar metastases may deserve to be studied separately [ 9 , 10 , 11 , 12 , 25 ]. The distribution of primary tumor histologies varies between posterior fossa and supratentorial metastases, i.e., the cerebellum is a predilection site for brain metastases from some (e.g., colorectal) cancers [ 1 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Arguments in favor include the negative prognostic impact of clinical (but not radiological) hydrocephalus and of a low preoperative KPI, i.e., “early” surgery before functional deterioration may produce better oncological results. Managing (symptomatic) hydrocephalus in patients with posterior fossa metastases can be challenging [ 9 ]. Temporary as well as permanent CSF diversion for hydrocephalus was associated with significant complications in the present series.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

Ersoy

Mokhtari

Brainman

et al. 2021

Cancers

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We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI <70% or multiple metastases survived >12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.

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“…Resection of brain metastases is an accepted therapeutic strategy for up to three large or symptomatic lesions. Masses in the cranial posterior fossa (PF) can cause a severe symptom burden due to vertigo, cranial nerve palsy, occlusive hydrocephalus or direct compression of structures within the brainstem [10,4,3]. Therefore, safe resection to maintain good postoperative functional status is of utmost importance to enable optimal comprehensive oncologic treatment [11].…”

Section: Introductionmentioning

confidence: 99%

Comparison of sitting position vs. non sitting position the resection of brain metastases in the posterior fossa. Surgical and functional outcome in a contemporary cohort.

Krauss

Vernik²,

Motov³

et al. 2022

Preprint

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For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or supine positioning for resective surgery of the posterior fossa are debated but contemporary data on direct postoperative outcome is rare. Aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in sitting vs. non sitting position in the direct postoperative setting. We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Either center performed surgery exclusively in sitting or non-sitting positioning respectively. Worse functional outcome (Karnofsky Performance scale) and functional deterioration was seen in the “sitting” group (coming from higher functional scores). We found significantly more “sitting” patients to deteriorate to a KPS ≤60% including four deaths (vs. one in non-sitting position). In this study, treating patients with brain metastases in sitting position resulted in a number needed to harm (NNH) of 2.3. In this study, we found sitting position for surgery of brain metastases to be associated with worse outcome and more adverse events. Therefore, we tend to recommend non-sitting over sitting position for surgery of brain metastases of the posterior fossa.

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Posterior Fossa Metastasis–Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery

Cited by 20 publications

References 65 publications

Outcome of Elderly Patients With Surgically Treated Brain Metastases

Outcome of Elderly Patients With Surgically Treated Brain Metastases

Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

Comparison of sitting position vs. non sitting position the resection of brain metastases in the posterior fossa. Surgical and functional outcome in a contemporary cohort.

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