Selective excision of cerebral metastases from the precentral gyrus

BACKGROUND: The surgical management of cerebral metastases to the eloquent cortex is a controversial topic. Precentral gyrus lesions are often treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) because of the concern for causing new or worsened postoperative neurological deficits. However, there is evidence in the literature that radiation therapy carries significant risk of complication. We present a series of patients who were symptomatic from a precentral gyrus metastasis and underwent surgical excision. METHODS: During a 2-year period from 2010 to 2012, 17 consecutive patients harboring a cerebral metastasis within the precentral gyrus underwent microsurgical resection. All patients were discussed at a multi-disciplinary tumor board. The prerequisite for neurosurgical treatment was stable systemic disease and life expectancy greater than 6 months as determined by the patient's oncologist. Patients also were required to harbor a symptomatic lesion within the motor cortex, defined as the precentral gyrus. RESULTS: We present the 3-month neurological outcome for this group of patients. Surgery was uneventful and without any severe perioperative complications in all 17 patients. At 3 month follow up, symptoms had improved or been stabilized in 94.1% of patients and were worsened in 5.9%. CONCLUSION: Our results have shown that surgery for cerebral metastases in the precentral gyrus can be done safely and improve or stabilize the neurological function of most patients. Microsurgical resection of precentral gyrus metastases should be a treatment option for patients with single or multiple lesions who present a focal neurologic deficit. This can be performed safely and without intraoperative cortical mapping.