Surgical treatment of brain metastases in the central region

J Neurosurg 126:698–707, 2017

Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not in ltrating intra- parenchymal tumors, eloquent areas can be affected. Therefore, this study aimed to describe the role of a functional guided approach for the resection of brain metastases in the central region.

METHODS Thirty-three patients (19 men and 14 women) with perirolandic metastases who were treated at the authors’ institution were reviewed. All participants underwent resection using a functional guided approach, which consisted of using intraoperative brain mapping and/or neurophysiological monitoring to aid in the resection, depending on the functionality of the brain parenchyma surrounding each metastasis. Motor and sensory functions were monitored in all patients, and supplementary motor and language area functions were assessed in 5 and 4 patients, respectively. Clinical data were analyzed at presentation, discharge, and the 6-month follow-up.

RESULTS The most frequent presenting symptom was seizure, followed by paresis. Gross-total removal of the metastasis was achieved in 31 patients (93.9%). There were 6 deaths during the follow-up period. After the removal of the metastasis, 6 patients (18.2%) presented with transient neurological worsening, of whom 4 had worsening of motor function impairment and 2 had acquired new sensory disturbances. Total recovery was achieved before the 3rd month of follow-up in all cases. Excluding those patients who died due to the progression of systemic illness, 88.9% of patients had a Karnofsky Performance Scale score greater than 80% at the 6-month follow-up. The mean survival time was 24.4 months after surgery.

CONCLUSIONS The implementation of intraoperative electrical brain stimulation techniques in the resection of central region metastases may improve surgical planning and resection and may spare eloquent areas. This approach also facilitates maximal resection in these and other critical functional areas, thereby helping to avoid new postoperative neurological deficits. Avoiding permanent neurological de cits is critical for a good quality of life, especially in patients with a life expectancy of over a year.

Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations

Neurosurg Rev (2010) 33:325–334.DOI 10.1007/s10143-010-0254-9

The authors critically analyzed a large series of patients with hemifacial spasm (HFS) and who underwent microvascular decompression (MVD) under a prospective protocol. We describe several “lessons learned” that are required for achieving successful surgery and proper postoperative management.

The purpose of this study is to report on our experience during the previous 10 years with this procedure and we also discuss various related topics.

From April 1997 to June 2009, over 1,200 consecutive patients underwent MVD for HFS. Among them, 1,174 patients who underwent MVD for HFS with a minimum 1 year follow-up were enrolled in the study. The median follow-up period was 3.5 years (range, 1-9.3 years). Based on the operative and medical records, the intraoperative findings and the postoperative outcomes were obtained and then analyzed. At the 1- year follow-up examination, 1,105 (94.1%) patients of the total 1,174 patients exhibited a “cured” state, and 69 (5.9%) patients had residual spasms. In all the patients, the major postoperative complications included transient hearing loss in 31 (2.6%), permanent hearing loss in 13 (1.1%), transient facial weakness in 86 (7.3%), permanent facial weakness in 9 (0.7%), cerebrospinal fluid leak in three (0.25%) and cerebellar infarction or hemorrhage in two (0.17%). There were no operative deaths.

Microvascular decompression is a very effective, safe modality of treatment for hemifacial spasm. MVD is not sophisticated surgery, but having a basic understanding of the surgical procedures is required to achieve successful surgery