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

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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.

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Authors and Affiliations

  1. Department for Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Marcel A. Kamp, Maxine Dibué, Lena Niemann, Hans-Jakob Steiger, Andrea Szelényi, Marion Rapp & Michael Sabel

  2. Department for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Dorothea C. Reichelt

  3. Department for Neuropathology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Jörg Felsberg

  4. Institute for Neurophysiology, University of Cologne, Robert-Koch-Straße 39, 50931, Cologne, Germany

    Maxine Dibué

  5. Center for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Straße 39, 50931, Cologne, Germany

    Maxine Dibué

  6. Neurochirurgische Klinik, Heinrich Heine University, Moorenstraße 5, Geb. 13.71, 40225, Düsseldorf, Germany

    Marcel A. Kamp

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  1. Marcel A. Kamp
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  2. Maxine Dibué
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  8. Marion Rapp
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  9. Michael Sabel
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Correspondence to Marcel A. Kamp.

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Kamp, M.A., Dibué, M., Niemann, L. et al. Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas. Acta Neurochir 154, 1981–1986 (2012). https://doi.org/10.1007/s00701-012-1463-5

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  • DOI: https://doi.org/10.1007/s00701-012-1463-5

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