Placido Bruzzaniti1,2, Pierfrancesco Lapolla3,4,5, Antonio Santoro1, Pietro Familiari1, Alessia D'Amico6,7, Giuseppa Zancana1, Michael Katsev1, Michela Relucenti4, Giuseppe Familiari4, Andrea Mingoli5, Giancarlo D'Andrea2, Alessandro Frati1,8, Maurizio Salvati9. 1. Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy. 2. Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy. 3. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, U.K. 4. Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy. 5. Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy. 6. Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy. 7. Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Division of Grottaferrata, Rome, Italy. 8. Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy. 9. Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata", Rome, Italy.
Abstract
BACKGROUND/AIM: The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. PATIENTS AND METHODS: We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. RESULTS: The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson's correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p<0.001. CONCLUSION: The overall mass effect of solitary supratentorial brain metastases is not correlated to the size of the lesion and the grade of the associated perilesional edema should be considered. Surgical en bloc resection can be considered the first choice of treatment in the presence of solitary metastasis ≤2 cm in maximal diameter but with high-grade edema, since this treatment reduces the overall mass effect.
BACKGROUND/AIM: The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. PATIENTS AND METHODS: We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. RESULTS: The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson's correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p<0.001. CONCLUSION: The overall mass effect of solitary supratentorial brain metastases is not correlated to the size of the lesion and the grade of the associated perilesional edema should be considered. Surgical en bloc resection can be considered the first choice of treatment in the presence of solitary metastasis ≤2 cm in maximal diameter but with high-grade edema, since this treatment reduces the overall mass effect.
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