PMID- 37945819 OWN - NLM STAT- MEDLINE DCOM- 20231201 LR - 20231216 IS - 1573-7373 (Electronic) IS - 0167-594X (Print) IS - 0167-594X (Linking) VI - 165 IP - 2 DP - 2023 Nov TI - Safety of microneurosurgical interventions for superficial and deep-seated brain metastases: single-center cohort study of 637 consecutive cases. PG - 271-278 LID - 10.1007/s11060-023-04478-1 [doi] AB - PURPOSE: Microneurosurgical techniques have greatly improved over the past years due to the introduction of new technology and surgical concepts. To reevaluate the role of micro-neurosurgery in brain metastases (BM) resection in the era of new systemic and local treatment options, its safety profile needs to be reassessed. The aim of this study was to analyze the rate of adverse events (AEs) according to a systematic, comprehensive and reliably reproducible grading system after microneurosurgical BM resection in a large and modern microneurosurgical series with special emphasis on anatomical location. METHODS: Prospectively collected cases of BM resection between 2013 and 2022 were retrospectively analyzed. Number of AEs, defined as any deviations from the expected postoperative course according to Clavien-Dindo-Grade (CDG) were evaluated. Patient, surgical, and lesion characteristics, including exact anatomic tumor locations, were analyzed using uni- and multivariate logistic regression and survival analysis to identify predictive factors for AEs. RESULTS: We identified 664 eligible patients with lung cancer being the most common primary tumor (44%), followed by melanoma (25%) and breast cancer (11%). 29 patients (4%) underwent biopsy only whereas BM were resected in 637 (96%) of cases. The overall rate of AEs was 8% at discharge. However, severe AEs (>/= CDG 3a; requiring surgical intervention under local/general anesthesia or ICU treatment) occurred in only 1.9% (n = 12) of cases with a perioperative mortality of 0.6% (n = 4). Infratentorial tumor location (OR 5.46, 95% 2.31-13.8, p = .001), reoperation (OR 2.31, 95% 1.07-4.81, p = .033) and central region tumor location (OR 3.03, 95% 1.03-8.60) showed to be significant predictors in a multivariate analysis for major AEs (CDG >/= 2 or new neurological deficits). Neither deep supratentorial nor central region tumors were associated with more major AEs compared to convexity lesions. CONCLUSIONS: Modern microneurosurgical resection can be considered an excellent option in the management of BM in terms of safety, as the overall rate of major AEs are very rare even in eloquent and deep-seated lesions. CI - (c) 2023. The Author(s). FAU - Voglis, Stefanos AU - Voglis S AUID- ORCID: 0000-0002-1514-1442 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. stefanos.voglis@usz.ch. FAU - Padevit, Luis AU - Padevit L AUID- ORCID: 0000-0003-2461-0404 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - van Niftrik, Christiaan Hendrik Bas AU - van Niftrik CHB AUID- ORCID: 0000-0003-0930-8717 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Kalin, Vincens AU - Kalin V AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Beyersdorf, Benjamin AU - Beyersdorf B AUID- ORCID: 0000-0001-9272-3115 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Da Mutten, Raffaele AU - Da Mutten R AUID- ORCID: 0000-0002-2645-0865 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Stumpo, Vittorio AU - Stumpo V AUID- ORCID: 0000-0002-8175-0035 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Bellomo, Jacopo AU - Bellomo J AUID- ORCID: 0009-0005-8945-4838 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Sarnthein, Johannes AU - Sarnthein J AUID- ORCID: 0000-0001-9141-381X AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Staartjes, Victor Egon AU - Staartjes VE AUID- ORCID: 0000-0003-1039-2098 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Carretta, Alessandro AU - Carretta A AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. AD - Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. FAU - Krayenbuhl, Niklaus AU - Krayenbuhl N AUID- ORCID: 0000-0002-4973-7527 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Regli, Luca AU - Regli L AUID- ORCID: 0000-0003-4639-4474 AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. FAU - Serra, Carlo AU - Serra C AUID- ORCID: 0000-0002-7305-550X AD - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. LA - eng PT - Journal Article DEP - 20231110 PL - United States TA - J Neurooncol JT - Journal of neuro-oncology JID - 8309335 SB - IM MH - Humans MH - Cohort Studies MH - Retrospective Studies MH - *Brain Neoplasms MH - Neurosurgical Procedures/adverse effects MH - *Lung Neoplasms/surgery PMC - PMC10689541 OTO - NOTNLM OT - Adverse events OT - Brain metastases OT - Complications OT - Surgical resection COIS- The authors have no relevant financial or non-financial interests to disclose. EDAT- 2023/11/10 00:44 MHDA- 2023/12/01 06:44 PMCR- 2023/11/10 CRDT- 2023/11/09 23:48 PHST- 2023/09/03 00:00 [received] PHST- 2023/10/10 00:00 [accepted] PHST- 2023/12/01 06:44 [medline] PHST- 2023/11/10 00:44 [pubmed] PHST- 2023/11/09 23:48 [entrez] PHST- 2023/11/10 00:00 [pmc-release] AID - 10.1007/s11060-023-04478-1 [pii] AID - 4478 [pii] AID - 10.1007/s11060-023-04478-1 [doi] PST - ppublish SO - J Neurooncol. 2023 Nov;165(2):271-278. doi: 10.1007/s11060-023-04478-1. Epub 2023 Nov 10.