Just recently, there are some hints that cerebral metastases infiltrate surrounding brain tissue, which might change the surgical and radiosurgical approach. Thus, surgical resection frequently treats metastases within or close to the motor cortex or corticospinal tract (CST). These patients are especially eligible for surgical resection to facilitate early recovery from neurological deficits. Nonetheless, many patients with supratentorial metastases show a focal deficit due to focal mass effects. By contrast, whole brain radiation therapy (WBRT) alone without surgery or radiosurgery led to significantly shorter survival and local control. Both radiosurgery and surgical resection have been shown to have comparable rates of local control. Modern treatment options for cerebral metastases limit surgical treatment to a subgroup of patients, which present with symptomatic lesions such as rolandic or cerebellar metastases. Today, treatment of cerebral metastases is a topic, which concerns many specialties and an interdisciplinary oncological cooperation is crucial to provide the best care for these patients. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered. Surgical resection is a safe treatment of brain metastases. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. This risk was even increased in perirolandic and rolandic lesions. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. In general, 8.7% of all patients postoperatively developed a new permanent paresis. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome. Methodsīetween 20, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients.
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