Postoperative Motor Trajectories and Their Impact on Survival After Resection of Motor Region Metastases

Surgical resection of brain metastases involving motor regions can preserve neurological function while improving oncological control. However, predictors of motor outcomes after surgery and their survival implications remain incompletely defined. This study evaluated preoperative clinical and radiographic features associated with motor deficits at presentation and aimed to correlate them with postoperative motor outcome trajectories and overall survival after resection.

A retrospective cohort study of patients with resected brain metastases involving motor regions was performed. Motor function was assessed immediately pre- and post-operatively, at 30 days, and followed for up to 90 days. Multivariable logistic and multinomial regression identified predictors of preoperative and postoperative motor outcomes. Cox proportional hazards model was used to determine the impact of these variables on 12-month survival.

Sixty patients with motor metastases were included. Preoperative motor deficits were common (74.2% arm; 43.9% leg). Improvement or resolution was observed in 50.0% of arm and 27.3% of leg deficits. New postoperative motor deficits of the arm or leg occurred in 16.7% of cases. 50% of new postoperative deficits recovered to baseline by 30 days. Higher preoperative performance status was independently associated with reduced odds of adverse motor outcomes, particularly for the upper extremity (odds ratio [OR] 0.87, P = .02). Tumor hemorrhage was associated with reduced likelihood of postoperative motor improvement (OR 18.33, P = .01) but not increased risk of deterioration (OR 5.12, P = .22). Persistent (hazard ratio [HR] 11.12, P = .04) or worsened (HR 14.7, P = .02) postoperative arm deficits, but not leg deficits, were associated with decreased overall survival. Hemorrhagic lesions also independently predicted worse survival (HR 3.95, P = .02).

Resection of motor metastases is associated with favorable neurological outcomes in most patients. Preoperative functional status and postoperative upper-extremity motor recovery were key determinants of survival, underscoring the importance of neurological preservation in surgical decision-making and patient counseling.