Operative treatment of subcortical metastatic tumours in the central region

The operative treatment of subcortical metastatic tumours within the paracentral area is still under discussion. Against the background of possible new postoperative neurological deficits and of evolving new radio oncological techniques, the indication for surgery is limited only to a subgroup of patients. In this retrospective study we present the clinical results after operative treatment of metastases within the central and paracentral brain region, with an emphasis on the short-term and mid-term functional outcome. We report on 20 patients suffering from subcortical brain metastases within the primary sensorimotor area, with a median volume on MRI-scans of 8.18 cmA(3). Patients were admitted to our department with a progressive hemiparesis (n = 11), focal seizures (n = 6) or other unspecific symptoms (n = 3) like headache, nausea, and neuropsychological disturbances, respectively. After updated MRI- and fMRI-scanning, intensive electrophysiological testing including MEP-brain mapping and interdisciplinary tumour-board discussion of each case, those patients were evaluated for surgery. Early postoperative control was done by MRI within the first 48 h. Follow-up took place in our outpatient department, assessing clinical criteria two and 6 weeks postoperatively, followed by clinical control and MRI-scans every 3 months. In all patients, surgery was performed under general anaesthesia, cranial neuro navigation and intraoperative motor cortex stimulation. Surgery and the early postoperative course were uneventful in all cases. After a 6 months follow-up, two patients had died. The motor deficits improved in seven patients and remained unchanged in four cases. One patient suffered from a new persistent hemiparesis. A temporary paresis occurred in two cases. In five patients there was no motor deficit pre- and postoperatively. The Karnofsky Performance Status improved in ten patients 6 months after surgery. Quality of Life, measured by the FACT-Br score, improved in 12 patients and remained unchanged in one patient. With modern techniques like fMRI-guided cranial neuronavigation and intraoperative neuromonitoring including direct stimulation of the motor cortex, microsurgical resection of subcortical paracentral metastases is feasible with an acceptable risk of neurological deterioration. Even preexistent deficits can improve with positive influence on the quality of life for oncological patients, being disabled by the symptoms caused by the cerebral lesion.