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

Abstract

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.

Surgical treatment of cerebellar metastases in elderly patients: A threshold that moves forward?

“…In this setting, surgery is potentially able i) to provide immediate symptomatic relief removing the mass effect of the lesion, ii) to possibly avoid the requirement of a definitive V–P shunt, iii) to shorten the need for corticosteroid therapy, iv) to provide tissue samples for further molecular analysis and, in combination with radiation, v) to improve the overall prognosis of the patients. 5 , 7 , 9 , 12 , 34 …”

“…Location in the vermis compared to hemispheric cerebellar metastatic lesions, predicted in Ersoy's series of 73 patients with cerebellar metastases and an average age of 60 years (range 30–82), the occurrence of surgical complications (45.5% vs 8.1%; p = 0.005), but this was not confirmed in our study. 9 …”

“…However, the definition of elderness remains unclear: traditionally subjects older than 65 years are considered elderly, although significant differences can be recognized among such patients. 6 , 8 , 9 …”

“…Such lesions, although generally considered to portend a poorer prognosis and to be associated to a higher risk of complications, than those in the supratentorial compartment, often require urgent surgical decision, even in older patients. 4 , 6 , 10 , 9 , 11 , 12 , 13 …”

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.

“…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].…”