• Isaac Phang, John Leach, Leggate James R S JRS Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom., Konstantina Karabatsou, David Coope, and Pietro I D'Urso.
• Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom.
• World Neurosurg. 2019 Oct 1; 130: e362-e367.

BackgroundMinimally invasive resection of brain metastases aims to maximize resection while minimizing brain trauma.MethodsPatients with 1 or more metastases that underwent resection following neuro-oncology multidisciplinary meeting discussion from September 2014 to October 2018, with pre- and postoperative magnetic resonance imaging, were included. All patients including posterior fossa metastases or multiple metastases were positioned supine. Hair was not shaved. Volumetric postcontrast T1 magnetic resonance imaging was used for incision planning and neuronavigation. The craniotomy site was tailored to tumor depth according to keyhole principles and ranged between 2 and 5 cm. Intraoperative monitoring and awake mapping were carried out in selected cases.ResultsOut of 320 consecutive patients with brain metastases, 44 patients were identified as suitable for minimally invasive resection. Nine patients had no postoperative imaging and were excluded. There were 38 metastases in 35 patients. There were 18 cerebellar metastases, 10 frontal, 3 parietal, 3 occipital, 2 temporal, 1 intraventricular, and 1 basal ganglia. Median length of stay was 3 days (range, 1-24). Average tumor volume was 54.7 cm3 (range, 10-240 cm3). Endoscopic assistance was used in 4 patients. Median performance status improved from 2 to 1 (range, preoperative: 0-4; postoperative: 0-2). Median survival was 14.7 months.ConclusionsMinimally invasive resection of brain metastasis is safe and effective, and in selected cases confers advantages compared with standard techniques.Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.

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