Leptomeningeal metastasis after surgical resection of brain metastases

Objective-To determine the incidence and risk factors for leptomeningeal me tastasis after surgery for brain metastasis of solid tumors. Methods-Review of the records of all patients operated on for brain metasta sis between January 1990 and August 1995. Results-In this period 28 patients underwent surgery for brain metastasis, of whom 27 were available for evaluation in this study. Median survival aft er craniotomy was 11 months. Nine patients (33%) developed leptomeningeal m etastasis 2-13 months after surgery, which included six of the nine patient s operated on for posterior fossa metastasis (p=0.05). In five patients, le ptomeningeal metastasis was the only site of recurrence. Three patients dev eloped the leptomeningeal metastasis as bulky tumour along the spinal cord, which is a rare presentation. No other risk factors for the development of leptomeningeal metastasis other than surgery for posterior fossa metastasi s were identified. Conclusions-There is an increased risk of leptomeningeal metastasis after s urgery for posterior fossa metastasis. Future trials should consider the va lue of an active approach to this complication in these patients.