Surgical management of posterior fossa metastases

Sunderland, Geraint; Jenkinson, Michael D.; Zakaria, Rasheed

doi:10.1007/s11060-016-2254-2

Cited by 34 publications

(42 citation statements)

References 34 publications

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“…The posterior fossa harbors 20–30% of all intracranial metastases. [ 10 22 44 47 ] These tumors are often neurologically impairing and potentially life-threatening. The most common primary origin is lung cancer, breast cancer, malignant melanoma, renal cell carcinoma, and colorectal and gynecological cancers.…”

Section: Introductionmentioning

confidence: 99%

“…The most common primary origin is lung cancer, breast cancer, malignant melanoma, renal cell carcinoma, and colorectal and gynecological cancers. [ 44 ] Their clinical presentation and evolution is mainly dependent on the lesion's location and growth rate. Symptoms may arise from focal compression of the cerebellum and vital brainstem nuclei, tonsillar herniation, and increased intracranial pressure due to obstructive hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

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The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Sinclair¹,

Benmakhlouf²,

Martin³

et al. 2018

Surg Neurol Int

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Background:Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression.Case Descriptions:Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus.Conclusion:For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Sinclair¹,

Benmakhlouf²,

Martin³

et al. 2018

Surg Neurol Int

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“…The median overall survival (OS) was 6.00 months. The 28 day mortality was 7.6 % (n = 7) with a perioperative morbidity of 22.8 % (n = 21) [24]. Zhang et.al, 2012 observed that the most common primary site of malignancy for brain metastasis was lung (20-40 %) followed by breast (5-17 %) and melanoma (7-11 %) with renal, colorectal and gynecological cancers making up the majority of the remaining [25].…”

Section: Discussionmentioning

confidence: 99%

Infra-Tentorial Brain Tumors – Biological Behavior during First Post-Operative Year – SKIMS, Kashmir Experience

Bhat¹,

Wani²,

Kirmani³

2020

Preprint

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Background: To observe the biological behavior like residual disease, progression, recurrence, disabilities, mortality, event free survival (EFS) etc., of histologically different infra-tentorial tumors of in the first postoperative year. Methods: The histopathological records of 410 infra-tentorial tumors out of 589 patients were compared with their clinical outcome up to first postoperative-year in a single-centre, amounting to regional epidemiological-value. In this observational study, retrospectively postoperative records of 589 infra-tentorial tumors of brain from Nov., 1990 to Dec., 2010 (20 years) were retrieved, scrutinized and compiled. The post-operative records of 410 patients with proved histopathological-examination results were included. Statistical law of Variance was applied where-ever necessary.Results: The 63.2% of 410 operated infra-tentorial tumors were males while females predominated in meningiomas and pineoblastomas. About 31.7% infra-tentorial or posterior fossa tumours were children (below-18yrs.). About 54.1% cases were histologically malignant. The residual-tumors comprised 40.2% and symptoms of disease-progression occurred in 10.9%. The tumor recurrence occurred in 14.3% while 6.0% patients developed severe-disability. The overall mortality was 11.4% up to first post-operative year with 18.9% in malignant patients. The first-one-year event-free-survival (EFS) for all the patients was 66.0%. While the patients with malignancies had first-one-year EFS of 47.7%, the histologically benign group had 87.7%. Conclusion: The first one-year postoperative biological behavior like EFS of histologically benign and some malignant infra-tentorial tumors both in children and adults like pilocytic astrocytomas, ependymomas and pineoblastomas was much better (87.7%) than other malignant infra-tentorial tumors.

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“…Although the surgeon believed that total resection had been done, it might have been incomplete due to the hindrance of the small and deep surgical field of cerebellum. Sunderland et al 17) reported that a significant increase of leptomeningeal metastasis with cerebellar tumor removed via a piecemeal approach compared with an en block resection. However, our data showed similar local control according to the methods of tumor removal in both supratententorial and cerebellar tumors.…”

Section: Discussionmentioning

confidence: 99%

Resection and Observation for Brain Metastasis without Prompt Postoperative Radiation Therapy

Song

Kim

Jung

et al. 2017

J Korean Neurosurg Soc

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ObjectiveTotal resection without consecutive postoperative whole brain radiation therapy is indicated for patients with a single or two sites of brain metastasis, with close follow-up by serial magnetic resonance imaging (MRI). In this study, we explored the effectiveness, usefulness, and safety of this follow-up regimen.MethodsFrom January 2006 to December 2015, a total of 109 patients (76 males, 33 females) underwent tumor resection as the first treatment for brain metastases (97 patients with single metastases, 12 with two metastases). The mean age was 59.8 years (range 27–80). The location of the 121 tumors in the 109 patients was supratentorial (n=98) and in the cerebellum (n=23). The origin of the primary cancers was lung (n=45), breast (n=17), gastrointestinal tract (n=18), hepatobiliary system (n=8), kidney (n=7), others (n=11), and unknown origin (n=3). The 121 tumors were totally resected. Follow-up involved regular clinical and MRI assessments. Recurrence-free survival (RFS) and overall survival (OS) after tumor resection were analyzed by Kaplan-Meier methods based on clinical prognostic factors.ResultsDuring the follow-up, MRI scans were done for 85 patients (78%) with 97 tumors. Fifty-six of the 97 tumors showed no recurrence without adjuvant local treatment, representing a numerical tumor recurrence-free rate of 57.7%. Mean and median RFS was 13.6 and 5.3 months, respectively. Kaplan-Meier analysis revealed the cerebellar location of the tumor as the only statistically significant prognostic factor related to RFS (p=0.020). Mean and median OS was 15.2 and 8.1 months, respectively. There were no significant prognostic factors related to OS. The survival rate at one year was 8.2% (9 of 109).ConclusionWith close and regular clinical and image follow-up, initial postoperative observation without prompt postoperative radiation therapy can be applied in patients of brain metastasi(e)s when both the tumor(s) are completely resected.

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Surgical management of posterior fossa metastases

Cited by 34 publications

References 34 publications

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases

Infra-Tentorial Brain Tumors – Biological Behavior during First Post-Operative Year – SKIMS, Kashmir Experience

Resection and Observation for Brain Metastasis without Prompt Postoperative Radiation Therapy

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