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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Comparison of the early functional outcome after electrophysiological controlled microsurgery versus stereotactic LINAC radiotherapy of cerebral metastasis of the Rolandic area

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  • Bogdan Pintea - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Deutschland; BG Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Bochum, Deutschland
  • Brigitta Baumert - Abteilung für Radiochirurgie und Stereotaktische Radiotherapie, Mediclin Robert Janker Klinik, Bonn, Deutschland
  • Thomas Mehari Kinfe - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
  • Konstantinos Gousias - BG Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Bochum, Deutschland
  • Yaroslav Parpaley - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Deutschland; Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum
  • Jan Boström - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Deutschland; Abteilung für Radiochirurgie und Stereotaktische Radiotherapie, Mediclin Robert Janker Klinik, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.03.02

doi: 10.3205/17dgnc015, urn:nbn:de:0183-17dgnc0157

Published: June 9, 2017

© 2017 Pintea et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To evaluate the advantages and disadvantages regarding the functional outcome and factors of influence of the two standard treatment options for central metastases: electrophysiologically controlled microsurgery or stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT).

Methods: We performed a database search for central metastasis treatments during the period from january 2008 till september 2012 in two clinical registers: 1. register for intraoperative neuromonitoring (Department of Neurosurgery) and 2. prospective database for SRS/SRT (Department of Radiotherapy). Neurological status before and after treatment, Karnofsky performance index (KPI), histology, tumor localisation, tumor volume and oncological status were standardized and pooled together. The muscle strength was graded on a scale of 0-5.

Results: We identified 27 microsurgical and 41 stereotactic cases in 68 patients. The microsurgically treated patients had significant less muscle strength in the upper and lower extremities before and after the treatment compared to the patients which received radiotherapy. The muscle strength of the limbs did not change in the patients which received radiotherapy, while operated patients had significant improvement of the muscle strength of the lower extremities (p=0.05) and a non-significant improvement in the upper extremities. There was a significant higher improvement rate of hemiparesis but as well a statistical trend for more deterioration of the muscle strength of the limbs after microsurgery compared to SRS/SRT (improvement p=0.04, deterioration p=0.10).

Conclusion: Electrophysiologically guided microsurgicy of central metastases had a significant better functional outcome regarding hemiparesis. However there was also a trend for less secondary neurological deterioration after stereotactic radiosurgery or stereotactic radiotherapy.