Current Perspectives in the Management of Brain Metastases
Current Perspectives in the Management of Brain Metastases
Surgical resection of a solitary metastatic tumor has been standard practice in patients with favorable features (e.g., accessibility of the tumor, good performance status, absent or controlled extracranial disease) (Soffietti, Rudà, & Trevisan, 2008). In addition, the use of stereotactic radiation surgery and novel radiosurgery techniques as part of initial treatment or salvage of recurrent BMs have increased (Karaiskos et al., 2014; Nabors et al., 2014). Additional considerations include the extent of neurologic deficit, time to metastasis, and histology and radiosensitivity of the primary tumor (Armstrong & Gilbert, 2000). Regardless of the extent of surgery (i.e., resection versus biopsy), neurosurgeons must carefully weigh the risk of new-onset or worsening neurologic deficits when treating BMs. Aside from neurologic deficits prompted by surgery, complications can include thromboembolic events, hematoma, and pseudomeningocele formation and infection, as well as local and distant recurrence (Armstrong & Gilbert, 2000).
Surgery
Surgical resection of a solitary metastatic tumor has been standard practice in patients with favorable features (e.g., accessibility of the tumor, good performance status, absent or controlled extracranial disease) (Soffietti, Rudà, & Trevisan, 2008). In addition, the use of stereotactic radiation surgery and novel radiosurgery techniques as part of initial treatment or salvage of recurrent BMs have increased (Karaiskos et al., 2014; Nabors et al., 2014). Additional considerations include the extent of neurologic deficit, time to metastasis, and histology and radiosensitivity of the primary tumor (Armstrong & Gilbert, 2000). Regardless of the extent of surgery (i.e., resection versus biopsy), neurosurgeons must carefully weigh the risk of new-onset or worsening neurologic deficits when treating BMs. Aside from neurologic deficits prompted by surgery, complications can include thromboembolic events, hematoma, and pseudomeningocele formation and infection, as well as local and distant recurrence (Armstrong & Gilbert, 2000).
Source...