Introduction. We have analysed a consecutive series of patients operated on for intracranial metastases from solid cancer irrespectively of their location (eloquent areas) or uniqueness (multiple lesions). This aggressive treatment should be matched with outpatient procedures like radiosurgery. Materials and methods. The study includes 61 consecutive patients treated from January 1993 to June 1997. Patients with absent, controlled, or limited systemic cancer were considered for aggressive therapy. Standardised operative procedures consisted of linear skin incision, minimal craniotomy and microsurgical resection by ultrasonography-guidance. Post-operative TC or MRI evaluation was obtained in all cases. Results. Median age was 60 yrs (34-74); 42 male and 19 female. Lesions were single in 51 cases and multiple in 10. There was no post-operative mortality and morbidity was 5%. In 7 patients with lesions sited in eloquent areas, no morbidity was observed and 3 of them improved after surgery. All metastases were superficially located and small in size with mean diameter of 2,5 cm. Operative time was within 2 hours for single lesions. Multiple craniotomies, in a single operation, were not associated with a higher post-craniotomy complication or 30-days mortality rates than a single craniotomy. Ninetyfive per cent of cases was disease-free at one month follow-up. Conclusions. Nowadays the morbidity of the minimally invasive microsurgery for small sized, superficially located metastases can be very low (5%). Suitable surgical technique minimising complication rate and improving its effectiveness (local control of disease in 95%) can be comparable with out-patient procedures like radiosurgery. The question of lesions in eloquent areas is an untrue problem: there was no site-related morbidity. One-stage surgery seems to us suitable for multiple lesion (10/61) and repeated operations seem feasible for local recurrence (5/61). The attitude of comparing surgery versus radiosurgery is probably wrong. After gross total removal there is a microscopic residual disease: the ideal condition for radiosurgical sterilisation.
|Number of pages||1|
|Journal||Italian Journal of Neurological Sciences|
|Publication status||Published - 1997|
ASJC Scopus subject areas
- Clinical Neurology