Brain metastases in osteosarcoma: incidence, clinical and neuroradiological findings and management options.

Brain metastasis is uncommon in osteosarcoma, but this may be changing with prolonged patient survival in the modern chemotherapy era. We present 5 patients with brain metastases out of 39 with lung metastasis (13%) in a total of 87 osteosarcoma patients. The clinical manifestations of brain metastases were catastrophic: massive hemorrhage in 2 and status epilepticus in 3. Metastases were single or multiple, and some were osteoblastic. Surgical intervention in 2 cases resulted in dramatic, though transient, clinical improvement. We advocate periodic neuroradiology screening in osteosarcoma patients with lung metastases, for early detection of brain involvement.