Skip to main content
Erschienen in: Acta Neurochirurgica 11/2012

01.11.2012 | Clinical Article

Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas

verfasst von: Marcel A. Kamp, Maxine Dibué, Lena Niemann, Dorothea C. Reichelt, Jörg Felsberg, Hans-Jakob Steiger, Andrea Szelényi, Marion Rapp, Michael Sabel

Erschienen in: Acta Neurochirurgica | Ausgabe 11/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Cerebral metastases are not sharply delimitatable; therefore, microsurgical circumferential stripping of intracerebral metastases is often insufficient for preventing local tumor recurrence. Supramarginal resection significantly improves local tumor control but was suggested not to be suitable for metastases in eloquent brain areas. Therefore, we retrospectively analyzed a series of patients with cerebral metastases situated in eloquent areas for newly occurring neurologic deficits after supramarginal resection performed as awake surgery.

Methods

A retrospective analysis was performed for all patients who underwent supramarginal resection for a cerebral metastasis performed as awake surgery between June 2011 and April 2012. All metastases were localized in eloquent brain areas. Pre- and postsurgical neurologic status was documented as well as data regarding the primary cancer and histopathologic data. Postoperative MRI within 72 h was scheduled routinely to verify complete resection.

Results

A total of 19 patients underwent awake surgery for a cerebral metastasis in eloquent brain areas. Surgery was well tolerated in all patients. Neurologic symptoms improved in five patients after surgery. In three patients, neurologic deficits existing before surgery worsened. The postoperative median National Institute of Health Stroke Scale (NIHSS) score did not differ from the preoperative value.

Conclusions

Awake surgery is a feasible tool for metastases in eloquent areas, minimizing postoperative neurologic deficits and morbidity. Therefore, eloquently situated metastases may also be eligible for supramarginal resection. Further studies are needed in order to analyze the benefit of this method in achieving better tumor control.
Literatur
1.
Zurück zum Zitat Bannur U, Rajshekhar V (2000) Post operative supplementary motor area syndrome: clinical features and outcome. Br J Neurosurg 14:204–210PubMedCrossRef Bannur U, Rajshekhar V (2000) Post operative supplementary motor area syndrome: clinical features and outcome. Br J Neurosurg 14:204–210PubMedCrossRef
2.
Zurück zum Zitat Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66:187–194PubMedCrossRef Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66:187–194PubMedCrossRef
3.
Zurück zum Zitat de Benedictis A, Moritz-Gasser S, Duffau H (2010) Awake mapping optimizes the extent of resection for low-grade gliomas in eloquent areas. Neurosurgery 66(6):1074–1084PubMedCrossRef de Benedictis A, Moritz-Gasser S, Duffau H (2010) Awake mapping optimizes the extent of resection for low-grade gliomas in eloquent areas. Neurosurgery 66(6):1074–1084PubMedCrossRef
4.
Zurück zum Zitat Duffau H (2001) Acute functional reorganisation of the human motor cortex during resection of central lesions: a study using intraoperative brain mapping. J Neurol Neurosurg Psychiatry 70:506–513PubMedCrossRef Duffau H (2001) Acute functional reorganisation of the human motor cortex during resection of central lesions: a study using intraoperative brain mapping. J Neurol Neurosurg Psychiatry 70:506–513PubMedCrossRef
5.
Zurück zum Zitat Duffau H, Bauchet L, Lehericy S, Capelle L (2001) Functional compensation of the left dominant insula for language. Neuroreport 12:2159–2163PubMedCrossRef Duffau H, Bauchet L, Lehericy S, Capelle L (2001) Functional compensation of the left dominant insula for language. Neuroreport 12:2159–2163PubMedCrossRef
6.
Zurück zum Zitat Duffau H, Capelle L, Denvile S, Sichez N, Gatignol P, Taillandier L, Lopes M, Mitchell MC, Roche S, Muller JC, Bitar A, Sichez JP, van Effenterre R (2003) Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 98:764–778PubMedCrossRef Duffau H, Capelle L, Denvile S, Sichez N, Gatignol P, Taillandier L, Lopes M, Mitchell MC, Roche S, Muller JC, Bitar A, Sichez JP, van Effenterre R (2003) Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 98:764–778PubMedCrossRef
7.
Zurück zum Zitat Fontaine D, Capelle L, Duffau H (2002) Somatotopy of the supplementary motor area: evidence from correlation of the extent of surgical resection with the clinical patterns of deficit. Neurosurgery 50:297–303PubMed Fontaine D, Capelle L, Duffau H (2002) Somatotopy of the supplementary motor area: evidence from correlation of the extent of surgical resection with the clinical patterns of deficit. Neurosurgery 50:297–303PubMed
8.
Zurück zum Zitat Kamp MA, Grosser P, Felsberg J, Slotty P, Steiger H-J, Reifenberger G, Sabel M (2012) 5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir (Wien) 154:223–228CrossRef Kamp MA, Grosser P, Felsberg J, Slotty P, Steiger H-J, Reifenberger G, Sabel M (2012) 5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir (Wien) 154:223–228CrossRef
9.
Zurück zum Zitat Korinth MC, Delonge C, Hutter BO, Gilsbach JM (2002) Prognostic factors for patients with microsurgically resected brain metastases. Onkologie 25:420–425PubMedCrossRef Korinth MC, Delonge C, Hutter BO, Gilsbach JM (2002) Prognostic factors for patients with microsurgically resected brain metastases. Onkologie 25:420–425PubMedCrossRef
10.
Zurück zum Zitat Muacevic A, Kreth FW, Horstmann GA, Schmid-Elsaesser R, Wowra B, Steiger H-J, Reulen HJ (1999) Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91:35–43PubMedCrossRef Muacevic A, Kreth FW, Horstmann GA, Schmid-Elsaesser R, Wowra B, Steiger H-J, Reulen HJ (1999) Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91:35–43PubMedCrossRef
11.
Zurück zum Zitat Neves S, Mazal PR, Wanschitz J, Rudnay AC, Drlicek M, Czech T, Wustinger C, Budka H (2001) Pseudogliomatous growth pattern of anaplastic small cell carcinomas metastatic to the brain. Clin Neuropathol 20:38–42PubMed Neves S, Mazal PR, Wanschitz J, Rudnay AC, Drlicek M, Czech T, Wustinger C, Budka H (2001) Pseudogliomatous growth pattern of anaplastic small cell carcinomas metastatic to the brain. Clin Neuropathol 20:38–42PubMed
12.
Zurück zum Zitat Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489PubMedCrossRef Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489PubMedCrossRef
13.
Zurück zum Zitat Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRef Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRef
14.
Zurück zum Zitat Pereira LC, Oliveira KM, L’Abbate GL, Sugai R, Ferreira JA, da Motta LA (2009) Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up. Acta Neurochir (Wien) 151(10):1215–1230CrossRef Pereira LC, Oliveira KM, L’Abbate GL, Sugai R, Ferreira JA, da Motta LA (2009) Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up. Acta Neurochir (Wien) 151(10):1215–1230CrossRef
15.
Zurück zum Zitat Picht T, Kombos T, Gramm HJ, Brock M, Suess O (2005) Mulitmodal protocol for awake craniotomy in language cortex tumour surgery. Acta Neurochir (Wien) 148(2):127–138CrossRef Picht T, Kombos T, Gramm HJ, Brock M, Suess O (2005) Mulitmodal protocol for awake craniotomy in language cortex tumour surgery. Acta Neurochir (Wien) 148(2):127–138CrossRef
16.
Zurück zum Zitat Regine WF, Schmitt FA, Scott CB, Dearth C, Patchell RA, Nichols RC Jr, Gore EM, Franklin RL III, Suh JH, Mehta MP (2004) Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of Radiation Therapy Oncology Group trial BR-0018. Int J Radiat Oncol Biol Phys 58:1346–1352PubMedCrossRef Regine WF, Schmitt FA, Scott CB, Dearth C, Patchell RA, Nichols RC Jr, Gore EM, Franklin RL III, Suh JH, Mehta MP (2004) Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of Radiation Therapy Oncology Group trial BR-0018. Int J Radiat Oncol Biol Phys 58:1346–1352PubMedCrossRef
17.
18.
Zurück zum Zitat Russell SM, Kelly PJ (2003) Incidence and clinical evolution of postoperative deficits after volumetric stereotactic resection of glial neoplasms involving the supplementary motor area. Neurosurgery 52:506–516PubMedCrossRef Russell SM, Kelly PJ (2003) Incidence and clinical evolution of postoperative deficits after volumetric stereotactic resection of glial neoplasms involving the supplementary motor area. Neurosurgery 52:506–516PubMedCrossRef
19.
Zurück zum Zitat Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1055PubMedCrossRef Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1055PubMedCrossRef
20.
Zurück zum Zitat Sills AK Jr (2005) Current treatment approaches to surgery for brain metastases. Neurosurgery 57(5 Suppl):S24–S32PubMed Sills AK Jr (2005) Current treatment approaches to surgery for brain metastases. Neurosurgery 57(5 Suppl):S24–S32PubMed
21.
Zurück zum Zitat Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401PubMedCrossRef Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401PubMedCrossRef
22.
Zurück zum Zitat Ulu MO, Tanriover N, Ozlen F, Sanus GZ, Tanriverdi T, Ozkara C, Uzan M (2008) Surgical treatment of lesions involving the supplementary motor area: clinical results of 12 patients. Turk Neurosurg 18:286–293PubMed Ulu MO, Tanriover N, Ozlen F, Sanus GZ, Tanriverdi T, Ozkara C, Uzan M (2008) Surgical treatment of lesions involving the supplementary motor area: clinical results of 12 patients. Turk Neurosurg 18:286–293PubMed
23.
Zurück zum Zitat Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590PubMedCrossRef Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590PubMedCrossRef
24.
Zurück zum Zitat Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, Zo JI, Lee SH (2009) Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 110:730–736PubMedCrossRef Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, Zo JI, Lee SH (2009) Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 110:730–736PubMedCrossRef
Metadaten
Titel
Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas
verfasst von
Marcel A. Kamp
Maxine Dibué
Lena Niemann
Dorothea C. Reichelt
Jörg Felsberg
Hans-Jakob Steiger
Andrea Szelényi
Marion Rapp
Michael Sabel
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Acta Neurochirurgica / Ausgabe 11/2012
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-012-1463-5

Weitere Artikel der Ausgabe 11/2012

Acta Neurochirurgica 11/2012 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.