Surgical Management of Brain Metastases

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Surgical Management of Brain Metastases Christopher P. Kellner, MD, Anthony L. D’Ambrosio, MD Neurosurgery Clinics Volume 22, Issue 1, Pages 53-59 (January 2011) DOI: 10.1016/j.nec.2010.08.003 Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 1 T1-weighted gadolinium-enhanced magnetic resonance images depicting preoperative (A, C, E) and 8-month postoperative (B, D, F) axial images of a 29-year-old woman presenting with three metastatic breast cancer lesions. The patient’s only presenting symptom was severe headaches. Karnofsky performance status at diagnosis and latest follow-up remains 100. Primary disease remains controlled with no evidence of extracranial tumor burden. The left occipital (A), right medial temporal (C), and left cerebellar (E) lesions were resected through three craniotomies and one surgical session. Stereotactic guidance was used intraoperatively. Postoperative radiation was administered in the form of focal fractionated tomotherapy. Each resection cavity received 4600 cGy at 200 cGy per fraction over 23 fractions. After radiation therapy, maintenance chemotherapy was reinitiated. Neurosurgery Clinics 2011 22, 53-59DOI: (10.1016/j.nec.2010.08.003) Copyright © 2011 Elsevier Inc. Terms and Conditions