Romanian Neurosurgery (Mar 2011)
Management of unknown origin cerebral metastases
Abstract
Aim: The present study attempts to determine the steps for obtaining the etiological diagnosis of brain metastases with unknown origin. Material and methods: A total of 190 patients with brain metastases diagnosed in the Department of Neurosurgery in Emergency Hospital ”N. Oblu” Iasi between 2007-2010 were included in this study. The clinical characteristics and pathological features were analyzed. Results: There were 102 males and 88 females with a M:F ratio of 1.15:1. The median age of patients was 47.07 years (range 31-77 years). Females patients were older (mean age 57.21 years) than males patients (49.15 years). 154 patients (81.05%) had single brain metastasis, and 36 patients (18.95%) had more than two. The lesions were supratentorial in 142 patients (74.73%), infratentorial in 18 (9.47%), and both infratentorial and supratentorial in 30 patients (15.78%). Surgical treatment involved complete resection in 47.9% of cases, subtotal resection in 26.8%, and biopsy alone in the remainder (25.3%). Brain metastases originating in lung cancer represented the most common type (47.39%), followed by those from breast cancer (19.79%), then those from skin (melanoma) (8.33%), genitourinary carcinoma (6.30%), and gastrointestinal carcinoma (2.62%). In 16.31% of cases, the primary tumor remained unknown, despite extensive investigation. Conclusion: The primary cancer leading to brain metastases can be detected either by obtaining a sample of tumoral tissue through a neurosurgical operation on the intracerebral tumor (total ablation or stereotactic biopsy) with histopathological examination, or by additional tests of the whole body. Taken into consideration the results of our own study, the management of the patients with brain metastases should include a thoracic CT scan or anteroposterior and lateral chest X-ray, clinical breast examination and mammography, abdominal ultrasound exploration, and skin, kidney and prostate examination. With the most sophisticated methods of diagnosis in approximately 16% of cases the origin of metastasis remains unknown. The identification of the primary site by the neuropathologist after stereotactic biopsy would clearly be advantageous.
