Direct extracranial spread of a brain metastasis through a craniotomy defect
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BRIEF REPORT Direct Extracranial Spread of a Brain Metastasis Through A Craniotomy Defect Wilmosh Mermershtain, MD, 1 * Ilan Shelef, MD, 2 Amiel Segal, MD, 1 Yancu Hertzanu, MD, 2 and Yoram Cohen, MD 1 Key words: small cell lung cancer; solitary brain metastasis; prophylactic brain irradiation Small cell lung cancer (SCLC) commonly metasta- sizes to the central nervous system (CNS). Because sys- temic chemotherapy for this disease has prolonged sur- vival, intracranial metastasis are encountered in as many as 80% of patients who survive for 2 years or more. One autopsy study has demonstrated brain metastases in 50% of patients with SCLC, 27% of which were solitary [1]. Craniotomy is therefore sometimes used in these pa- tients. Seeding of metastases along routes of invasive procedures—fine-needle aspirations, thoracoscopies, percutaneous transhepatic procedures, laparascopic cho- lecystectomies, chest tube placements, T-tube drainage procedures—have been well described [2–5], but our re- view of the literature has not revealed a report of an intracranial metastasis spreading through previously drilled burr holes. Our experience with such a patient is therefore of interest. The patient, a 61-year-old woman diagnosed with SCLC, limited disease, involving the right middle lobe and right main bronchus, was treated with combined che- moradiotherapy. She underwent a right frontotemporal craniotomy to remove an isolated metastasis 2.5 years later and received, by the stereotactic technique, an additional 1,800 cGy in a single high-dose treatment to the tumor bed. Six months thereafter, a tumor of the scalp was biopsied; this proved on CT to be an extension of the intracranial metastasis through the previously drilled burr hole in the frontal-temporal bone (Fig. 1). A seemingly complete re- mission was achieved after three courses of cisplatin and etoposide, but the patient died 7 months after completion of treatment because of recurrent brain metastases. DISCUSSION The survival of patients with SCLC has increased, particularly that of patients with limited disease. When prophylactic cranial irradiation (PCI) is given, the CNS is the sole site of relapse in fewer than 5% of cases [6,7]. The CNS metastasis in our patient occurred after she had received PCI and appeared to be the sole site of relapse. Three-dimensional computerized tomographic recon- struction was used to demonstrate the spread of the tumor from an intracranial metastasis through previously drilled burr holes to involve the overlying scalp. 1 Department of Oncology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel 2 Department of Radiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel *Correspondence to: Wilmosh Mermershtain, MD, Department of On- cology, Soroka Medical Center, Beer-Sheva P.O.B. 151, Israel 84101. E-mail: [email protected] Received 4 June 1999; Accepted 2 August 1999 Fig. 1. Postcontrast CT showing local recurrence in the right tem- poral lobe (three arrows) with spread through the burr hole (single arrow) to the scalp (dart). Medical and Pediatric Oncology 34:74–75 (2000) © 2000 Wiley-Liss, Inc.
Transcript of Direct extracranial spread of a brain metastasis through a craniotomy defect
BRIEF REPORTDirect Extracranial Spread of a Brain Metastasis Through A Craniotomy Defect
Wilmosh Mermershtain, MD,1* Ilan Shelef, MD,2 Amiel Segal, MD,1
Yancu Hertzanu, MD,2 and Yoram Cohen, MD1
Key words: small cell lung cancer; solitary brain metastasis; prophylacticbrain irradiation
Small cell lung cancer (SCLC) commonly metasta-sizes to the central nervous system (CNS). Because sys-temic chemotherapy for this disease has prolonged sur-vival, intracranial metastasis are encountered in as manyas 80% of patients who survive for 2 years or more. Oneautopsy study has demonstrated brain metastases in 50%of patients with SCLC, 27% of which were solitary [1].Craniotomy is therefore sometimes used in these pa-tients. Seeding of metastases along routes of invasiveprocedures—fine-needle aspirations, thoracoscopies,percutaneous transhepatic procedures, laparascopic cho-lecystectomies, chest tube placements, T-tube drainageprocedures—have been well described [2–5], but our re-view of the literature has not revealed a report of anintracranial metastasis spreading through previouslydrilled burr holes. Our experience with such a patient istherefore of interest.
The patient, a 61-year-old woman diagnosed withSCLC, limited disease, involving the right middle lobeand right main bronchus, was treated with combined che-moradiotherapy. She underwent a right frontotemporalcraniotomy to remove an isolated metastasis 2.5 years laterand received, by the stereotactic technique, an additional1,800 cGy in a single high-dose treatment to the tumor bed.Six months thereafter, a tumor of the scalp was biopsied;this proved on CT to be an extension of the intracranialmetastasis through the previously drilled burr hole in thefrontal-temporal bone (Fig. 1). A seemingly complete re-mission was achieved after three courses of cisplatin andetoposide, but the patient died 7 months after completion oftreatment because of recurrent brain metastases.
DISCUSSION
The survival of patients with SCLC has increased,particularly that of patients with limited disease. Whenprophylactic cranial irradiation (PCI) is given, the CNS isthe sole site of relapse in fewer than 5% of cases [6,7].The CNS metastasis in our patient occurred after she hadreceived PCI and appeared to be the sole site of relapse.Three-dimensional computerized tomographic recon-struction was used to demonstrate the spread of the tumor
from an intracranial metastasis through previously drilledburr holes to involve the overlying scalp.
1Department of Oncology, Soroka Medical Center, Faculty of HealthSciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel2Department of Radiology, Soroka Medical Center, Faculty of HealthSciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*Correspondence to: Wilmosh Mermershtain, MD, Department of On-cology, Soroka Medical Center, Beer-Sheva P.O.B. 151, Israel 84101.E-mail: [email protected]
Received 4 June 1999; Accepted 2 August 1999
Fig. 1. Postcontrast CT showing local recurrence in the right tem-poral lobe (three arrows) with spread through the burr hole (singlearrow) to the scalp (dart).
Medical and Pediatric Oncology 34:74–75 (2000)
© 2000 Wiley-Liss, Inc.
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