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Selective Excision of Metastatic Brain Tumors Originating in the Motor Cortex With Preservation of Function

From the Brain Tumor Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN; and the Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

Address reprint requests to Robert J. Weil, MD, Brain Tumor Institute, Taussig Cancer Center/Desk R-20, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: weilr{at}ccf.org

PURPOSE: Brain metastases are common in patients with cancer and can cause considerable morbidity or death. Metastasis in eloquent areas of the brain, particularly the primary motor cortex, may present significant treatment challenges.

PATIENTS AND METHODS: Seventeen consecutive patients with metastasis within the primary motor cortex underwent selective microsurgical tumor resection. Operative, hospital, neuroimaging, and follow-up information was reviewed.

RESULTS: There were 10 women and seven men (mean age, 54.3 years) who underwent 17 operations for symptomatic brain metastases. Motor cortex was identified and tumor (mean volume, 10.2 cm³) was completely resected in all patients. Three patients had transient or reversible complications. Karnofsky performance scores improved in 16 of 17 patients at 4 weeks postoperatively, with a mean improvement of 1.8 grades compared with preoperative scores (P < .05). Overall survival of 16 patients with distant follow-up (> 6 months or until death) averaged 10.6 ± 4.4 months, with nine of 16 (56%) assessable patients surviving 1 year or longer. Survival of these 16 patients, by recursive partitioning analysis (RPA), was 11.2, 13.3, and 6.7 months for RPA classes I, II, and III, respectively. The cause of death in 14 of 15 patients who have died was progressive systemic disease; in one patient it was a combination of systemic and distant CNS disease progression. There were no local CNS recurrences.

CONCLUSION: Complete microsurgical resection of metastatic tumors in the primary motor cortex is feasible and efficacious, results in a sustained improvement in performance outcomes, and permits satisfactory long-term survival.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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