Image-guided craniotomy for cerebral metastases: techniques and outcomes

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Brain metastases pose significant challenges in neuro-oncology.
• Image-guided technologies are increasingly utilized in neurosurgical procedures.
• Intraoperative MRI and advanced navigation systems enhance surgical precision.

Purpose of the Study:

• To evaluate the outcomes of craniotomies for brain metastases using image-guided technologies.
• To assess the safety and efficacy of image-guided surgery in both standard operating rooms and intraoperative MRI suites.
• To analyze patient outcomes based on tumor location and Radiation Therapy Oncology Group (RPA) classification.

Main Methods:

• Analysis of 49 patients undergoing 55 image-guided craniotomies for brain metastases over a 5-year period.
• Tumor locations categorized as critical or noncritical function areas.
• Patients classified into RPA classes based on prognostic factors; anesthesia varied by tumor location (sedation for critical, general for noncritical).

Main Results:

• No perioperative mortality; 96% gross total resection achieved.
• Median hospital stay was 3 days; 70% of symptomatic patients experienced complete symptom resolution.
• 93% of patients maintained or improved functional status; median survival was 16.23 months.

Conclusions:

• Image-guided systems enable safe gross total resection of brain metastases, even in critical brain areas, with low morbidity.
• Aggressive surgical and radiation treatment is beneficial for RPA Class I and II patients with controlled primary disease.
• Contemporary image-guided craniotomies represent an effective treatment modality for brain metastases.