Artikel
Operation of single brain metastases in elderly patients
Operation singulärer Hirnmetastasen bei älteren Patienten
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
There are different opinions on treating single brain metastases in patients of 65 years and older primarily either with radiation therapy or with microsurgical resection. The data acquired in this study questions the ratio between the risk and the benefit of microsurgical operation before radiation therapy.
Methods
48 patients where operated on single brain metastases with the attempt of total resection in the years of 1999 to 2003. All had reached at least 65 years. In addition to postoperative complications, other pre-existing diseases such as medical treatment with at least 4 medicaments or lack of mobility because of other illness was documented. Neurological deficits and the average time of hospitalisation were acquired. Complications were defined as re-bleeding, wound infection, cerebro-spinal-fluid fistula, palsy of one or two limbs, as well as other neurological deficits which occurred in the course of operation.
Results
At the time of surgical intervention, nearly 50 % of all patients were in some way disabled because of other illnesses beside the brain metastases. Nevertheless a good or excellent outcome in more than 2/3 of patients with regard to activity of daily living was seen. There were significant postoperative complications in less than 25 % of patients. The average time of hospitalisation was below 18 days. Our data show that the risk of life threatening complications dew of operative intervention lies at about 1%.
Conclusions
Even in elderly patients with pre-existing illness of different degree and the risk of complications in the course of operation, microsurgical resection of single brain metastases seems to be an appropriate method to positively influence the quality of live. We recommend microsurgical resection of single metastases in elderly patients if the patient's general conditions is adequate.