The role of surgical resection in patients with single large brain metastases: feasibility, morbidity and local control evaluation

The role of surgical resection in patients with single large brain metastases: feasibility, morbidity and local control evaluation
Original article –  World Neurosurgery Available online 30 June 2016


To investigate the role of surgical resection for single large brain metastases

To focus on supramarginal resection in non-eloquente or near eloquent areas

Clinical remission achieved in 90.5% of 69 cases studies

No neurological deficit, major complication or CSF leakage reported

Two year LC was 100%. Two-year OS was73%.



The aim of this study was to evaluate the safety and the feasibility of surgery for single large brain metastases.


This retrospective study included 69 patients. All received a “supramarginal resection” according with functional boundaries, defined as a microsurgical excision with an extension larger at least 5 mm than enhancing T1 weighted magnetic resonance imaging (MRI) sequences borders with dural attachment radicalization. Hypofractionated stereotactic radiosurgery on the tumor bed, using 30Gy in three fractions, was performed within one month after surgery. Clinical outcome was evaluated at thirty-days postoperative and by MRI performed every 3 months. The appearance of post-operative neurological deficits, local control (LC), brain distant progression (BDP) and overall survival (OS) were evaluated.


Clinical remission of symptomatology was obtained in 90.5%. No patients had new neurological deficit or worsening of preoperative functional status. No major complications or cerebro-spinal fluid leakage occurred. No residual tumor was detected on postoperative-MRI. The median follow-up was 24 months (range 4-33 months). The 1-2- year LC was 100%. Twenty-four (29%) patients had new BDP and 75% also extracranial progression. The median, 1-2-year overall survival was 24 months, 91.3% and 73%. At the last observation time, 15 (21.7%) patients are dead and 54 (78.3%) alive.


Supramaginal resection along with dural attachment radicalization has proved to be a safe and effective strategy for selected patients with single large brain metastases.


  • single large brain metastases;
  • supramarginal resection;
  • surgery in eloquent areas


Categories: Brain Tumor, Radiosurgery

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