Neurosurgical resection is one of the primary management strategies in patients with large, symptomatic brain metastases. Some studies have detected that neurosurgical resection for brain metastases might be associated with the risk of incidence of pachymeningeal seeding. This study aims to examine the association between neurosurgical resection and the incidence of pachymeningeal seeding.
This retrospective cohort study included a consecutive sample of 1,188 patients with newly diagnosed brain metastases managed with neurosurgical resection and stereotactic radiation (n=318) or stereotactic radiation alone (n=870). The primary outcome of the study was the incidence of pachymeningeal seeding and leptomeningeal disease, along with risk factors and outcomes associated with pachymeningeal seeding.
The findings suggested that resection was associated with an increased risk of pachymeningeal seeding (36 of 318 patients) but not with stereotactic radiation (0 of 870 patients). Neither of the two procedures was, however, associated with a risk of leptomeningeal disease. Of 428 operations, 36 (8.4%) were complicated by pachymeningeal seeding, with the incidence being higher with resection of previously irradiated vs. unirradiated metastases. Pachymeningeal seeding was associated with low rates of development of new brain metastasis, but it increased the risk of neurologic death (72%).
The research concluded that in patients with brain metastasis, those who underwent neurosurgical resection were at a higher risk of pachymeningeal seeding.