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Leptomeningeal metastasis after surgical resection of brain metastases
T C van der Ree1, D W Dippel, C J Avezaat
1Department of Neuro-Oncology, Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Objective:
To determine the incidence and risk factors for leptomeningeal metastasis after surgery for brain metastasis of solid tumors.
Methods:
Review of the records of all patients operated on for brain metastasis between January 1990 and August 1995.
Results:
In this period 28 patients underwent surgery for brain metastasis, of whom 27 were available for evaluation in this study. Median survival after craniotomy was 11 months. Nine patients (33%) developed leptomeningeal metastasis 2-13 months after surgery, which included six of the nine patients operated on for posterior fossa metastasis (p=0.05). In five patients, leptomeningeal metastasis was the only site of recurrence. Three patients developed the leptomeningeal metastasis as bulky tumour along the spinal cord, which is a rare presentation. No other risk factors for the development of leptomeningeal metastasis other than surgery for posterior fossa metastasis were identified.
Conclusions:
There is an increased risk of leptomeningeal metastasis after surgery for posterior fossa metastasis. Future trials should consider the value of an active approach to this complication in these patients.