Cerebral Metastases as a Cause of Non-Traumatic Intracranial Hemorrhage: Long-Term Results of Surgical Treatment

Abstract

Prozorenko E.V, Davydov M.M, Sevyan N.V, Glushakov R.I, Mitrofanov A.A.

Hemorrhages from brain tumors are the second most frequent cause of spontaneous intracerebral hemorrhages, with metastatic tumors more often leading to hemorrhages. We have studied the long-term results of surgical treatment of metastatic brain lesion complicated by hemorrhage in the tumor. Materials and methods. From 2005 to 2013, 264 patients from three clinical centers were operated on, of which 87 (32.95%) recorded hemorrhages from metastases. All metastatic tumors and associated hematomas were removed microsurgically, while block removal of neoplasms was performed in 195 (73.9%) patients, in 69 (26.1%) neoplasms were removed by fragmentation. Patients were stratified according to the histological structure of the primary tumor, and also divided into classes of RPA (recursive partition analysis). The interval of observation of patients (from the operation to a clinically significant event) ranged from 1 to 72 months, the median of observation was 22.6 months. Such aspects of treatment as the frequency of local relapses, the median of non-progressive and overall survival after surgical removal of metastases were retrospectively studied. Results. Local relapses occurred in 14 (16.1%) patients from the group of patients with tumor hemorrhages and 47 (26.6%) in the remaining cohort of patients with cerebral metastases (χ2 = 3.59, p = 0.059; φ = 1.97, p> 0.05). The local recurrence rate was 11.7% with block removal of metastases, and 25.9% with fragmentary removal (χ2 = 2.804, p = 0.095, φ = 1.597 p> 0.05). The medians of non-progressive and overall survival after surgery among all patients did not exceed 4.9 and 9.3 months, respectively, while the minimum values were observed with metastatic melanoma (1.6 and 6.0 months, respectively) and class III of RPA (3.6 and 6.5 months, respectively).