The simultaneous removal of multiple cerebral metastases without changing the patient’s position on operating table

Multiple cerebral metastases, causing the neurological and mental disorders, quickly lead to disability and lethality. The aim of this investigation was to develop optimal surgical approach for patients with multiple brain metastases as well as to evaluate the outcomes and to determine the prognostic factors. Material and methods. 54 patients with multiple brain metastases were operated on, 138 metastatic foci were removed. The simultaneous removal of metastases without changing the patient’s position was performed in 52 cases. Total removal of all metastases was performed in 39 persons, whole brain radiation therapy was applied for 35 patients. Results. The method of simultaneous removal of multiple brain metastases without changing the patient’s position was developed. The median survival time for the whole group was 7.2 months; for patients with complete resection of metastases - 1.8 months. Two-year survival rate was 9.3 %. Adjuvant whole brain radiation therapy after resection prolonged the median survival time up to 12.7 months compared to 4.7 months in patients who received only symptomatic treatment. The median survival time for patients with a preoperative Karnofsky performance score <70 was significantly lower than for patients with Karnofsky performance score >70. Conclusion. The method of simultaneous removal of multiple brain metastases without changing the patient’s position is considered as optimal. The surgical treatment rapidly improves the condition of patients with multiple brain metastases, saving time for postoperative adjuvant treatment. Median survival time for patients with totally removed of all metastases achieves 11.8 months. The favorable prognostic factors for prolonged survival are the following: total resection of all metastatic lesions, preoperative Karnofsky performance score >70 and adjuvant whole brain radiation therapy.

множественные церебральные метастазы, оперативное лечение, прогностические факторы, multiple brain metastases, surgery, prognostic factors

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