Abstract
Background and Study Aims/Objective Metastatic brain tumors are the most common type of adult brain tumors. Treatment
involves surgery and/or radiation therapy. Surgery is typically reserved for patients
with good neurologic function, solitary and accessible lesions, symptomatic lesions,
and/or those with good systemic control of their primary cancer. Deep-seated lesions,
however, are typically treated with palliative options including radiation and medical
therapies. We summarize our personal experience with minimally invasive surgical approaches
for these deep-seated metastatic brain tumors using tubular retractors with exoscopic
visualization.
Material and Methods Patients with deep-seated metastatic brain tumors who were operated on from January
2016 to December 2017 by the senior author were collected prospectively. “Deep seated”
was defined as any subcortical location below the deepest adjacent sulcus in close
proximity to the basal ganglia and/or thalamus. “Minimally invasive” was defined as
the use of tubular retractors with exoscopic visualization.
Results A total of 15 consecutive patients with an average ± standard deviation age of 63 ± 12
years underwent surgical resection of a deep-seated metastasis. The tumor was located
in the centrum semiovale in seven (47%) (3 corticospinal tract, 2 superior longitudinal
fasciculus, 1 visual tract, 1 inferior frontal occipital fasciculus), basal ganglia
in three (20%), thalamus in two (13%), and cerebellum in three (20%). Median percentage
resection was 100% (interquartile range:100–100%), and, following surgery, seven (47%),
seven (47%), and one (7%) had an improved, stable, and worse Karnofsky Performance
Score, respectively. No patients had notable local complications including stroke,
infection, hemorrhage, and/or seizure. All patients underwent postoperative stereotactic
radiosurgery.
Conclusion This minimally invasive approach can be used to achieve extensive resection with
minimal morbidity for arguably the highest risk metastatic brain tumors.
Keywords
deep seated - exoscope - metastatic brain tumors - minimally invasive approaches -
tubular retractors
