METASTATIC BRAIN-TUMORS WITH DURAL EXTENSION

Object. Twenty-two patients who had solitary metastatic brain tumors w ith dural extension were treated surgically over a 3-year period. Thei r cases were reviewed to characterize these lesions and to compare the patients with a similar cohort in which there was no dural involvemen t. Methods. The median age of the patients was 58 years (range 11-68 y ears) and the male/female ratio was 12:10. The median preoperative Kar nofsky Performance Scale (KPS) score in the group was 90(range 70-100) . The most common histological diagnoses seen in these patients includ ed boast cancer, adenocarcinoma and squamous cell carcinoma of the lun g, and renal cell carcinoma. All patients underwent gross-total resect ion of the tumor and 86% received radiation therapy. The median patien t survival time was 11 months, with a median time to recurrent intracr anial disease of 19 months. Survival was related to the histological d iagnosis. Recurrent disease occurred in 41% Of cases. Leptomeningeal d isease occurred in three patients (14%). The frequency and time course of development of recurrent disease was not affected by dural resecti on nor was survival. These results for patients having metastatic brai n tumors with dural extension were compared with those for a cohort of 26 patients in which there were similar histological diagnosis, age, gender, and preoperative KPS score were distributed similarly but in w hich each patient had a single subcortical metastatic lesion. Those pa tients had a median survival of 10 months and the median time to recur rence was not reached. Leptomeningeal disease occurred in one patient (4%). Conclusions. To the authors' knowledge, this is the first report ed series of patients with metastatic brain tumors with dural extensio n. Patients with this disease may be more likely to develop recurrence s along the dura and leptomeningeal disease, but the overall survival time in these patients is not different from those patients with intra parenchymal lesions.