Secondary Neoplastic Brain Tumors: A 10-Year Single-Center Experience

Öz

Objective: Brain metastases (BMs) are the most common intracranial tumors in adults and represent a major cause of morbidity and mortality in patients with systemic malignancies. This study aimed to evaluate the clinical characteristics, surgical management, and outcomes of patients who underwent surgery for brain metastases over a 10-year period and to assess the impact of intraoperative technologies on surgical outcomes. Methods: This retrospective study included patients who underwent surgery for intracranial tumors between 2013 and 2023. Among 513 operated patients, 114 with histopathologically confirmed brain metastases were analyzed. Demographic characteristics, primary tumor origin, diagnostic modalities, lesion number and location, treatment strategies, and postoperative outcomes were evaluated. The impact of intraoperative neuronavigation and intraoperative ultrasound on surgical outcomes and reoperation rates was also analyzed. Results: Of the 513 patients, 114 (22.2%) were diagnosed with brain metastases. The mean age was 59.1 years (range, 31–85), and the male-to-female ratio was 56.2% to 43.8%. The most common primary tumors were lung (52.6%), breast (19.2%), and gastrointestinal cancers (8.8%). Metastases were predominantly infratentorial (57.9%), and solitary lesions were observed in 52.6% of cases. Intraoperative neuronavigation was used in 68.4% of cases, and neuronavigation combined with intraoperative ultrasound was used in 24.5%. Reoperation rates were significantly lower in cases where intraoperative imaging modalities were utilized compared to those without additional intraoperative tools (P<.001). Postoperative adjuvant therapy was administered in 75.4% of patients, with a recurrence rate of 12.7%. The median survival time was 22 months. Conclusion: Brain metastases remain a major clinical challenge requiring individualized treatment strategies. Surgical resection plays a critical role in selected patients by providing rapid relief of mass effect and improving neurological outcomes. The use of intraoperative technologies, particularly neuronavigation and intraoperative ultrasound, significantly contributes to improved surgical precision and reduced reoperation rates. Appropriate patient selection, meticulous preoperative planning, and the integration of advanced intraoperative tools may improve survival and quality of life in patients with brain metastases.

Anahtar Kelimeler

• Brain metastasis
• neurosurgery
• neuronavigation
• intraoperative ultrasound
• surgical outcomes

İkincil Neoplastik Beyin Tümörleri: 10 Yıllık Tek Merkez Deneyimi

Öz

Amaç: Beyin metastazları (BM), yetişkinlerde en sık görülen intrakraniyal tümörler olup, sistemik maligniteleri olan hastalarda önemli bir morbidite ve mortalite nedenidir. Bu çalışmanın amacı, 10 yıllık süreçte beyin metastazı nedeniyle opere edilen hastaların klinik özelliklerini, cerrahi tedavi sonuçlarını değerlendirmek ve intraoperatif teknolojilerin cerrahi sonuçlar üzerindeki etkisini incelemektir. Yöntemler: Bu retrospektif çalışmada, 2013–2023 yılları arasında intrakraniyal tümör nedeniyle opere edilen hastalar incelendi. Toplam 513 hasta arasından histopatolojik olarak beyin metastazı tanısı doğrulanan 114 hasta analiz edildi. Demografik özellikler, primer tümör kökeni, tanı yöntemleri, lezyon sayısı ve lokalizasyonu, tedavi stratejileri ve postoperatif sonuçlar değerlendirildi. Ayrıca intraoperatif nöronavigasyon ve intraoperatif ultrason kullanımının cerrahi sonuçlar ve reoperasyon oranları üzerindeki etkisi analiz edildi. Bulgular: Toplam 513 hasta arasında 114 (%22,2) hastada beyin metastazı saptandı. Ortalama yaş 59,1 (31–85) olup, erkek/kadın oranı %56,2/%43,8 idi. En sık primer tümörler akciğer (%52,6), meme (%19,2) ve gastrointestinal sistem (%8,8) kaynaklıydı. Metastazlar ağırlıklı olarak infratentoryal (%57,9) yerleşimli olup, vakaların %52,6’sında soliter lezyon saptandı. Olguların %68,4’ünde intraoperatif nöronavigasyon, %24,5’inde ise nöronavigasyon ile birlikte intraoperatif ultrason kullanıldı. İntraoperatif görüntüleme yöntemlerinin kullanıldığı vakalarda reoperasyon oranları, ek intraoperatif araç kullanılmayanlara kıyasla anlamlı derecede daha düşüktü (P<,001). Hastaların %75,4’üne adjuvan tedavi uygulanmış olup, nüks oranı %12,7 olarak bulundu. Medyan sağkalım süresi 22 aydı. Sonuç: Beyin metastazları, bireyselleştirilmiş tedavi stratejileri gerektiren önemli bir klinik sorundur. Cerrahi rezeksiyon, kitle etkisini hızlı şekilde ortadan kaldırarak ve nörolojik sonuçları iyileştirerek seçilmiş hastalarda kritik bir rol oynamaktadır. Özellikle nöronavigasyon ve intraoperatif ultrason gibi intraoperatif teknolojilerin kullanımı cerrahi hassasiyeti artırmakta ve reoperasyon oranlarını anlamlı şekilde azaltmaktadır. Uygun hasta seçimi, titiz preoperatif planlama ve ileri intraoperatif tekniklerin kullanımı, hastaların sağkalımını ve yaşam kalitesini artırabilir.

Anahtar Kelimeler

• Beyin metastazı
• nöroşirürji
• nöronavigasyon
• intraoperatif ultrason
• cerrahi sonuçlar

Kaynakça

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