Surgical resection of calvarial metastases overlying dural sinuses

OBJECTIVE: Few reports have addressed the surgical management of cranial me tastases that overlie or invade the dural venous sinuses. To examine the ro le of surgery in the treatment of dural sinus calvarial metastases, we revi ewed retrospectively 13 patients who were treated with surgery at the Unive rsity of Texas M.D. Anderson Cancer Center between 1993 and 1999. We compar ed them with 14 patients who had calvarial metastases that did not involve a venous sinus. METHODS: Clinical charts, radiological studies, pathological findings, and operative reports were analyzed retrospectively. RESULTS: The median age of patients with dural sinus calvarial metastases w as 54 years. Nine patients were men and four were women. Renal cell carcino ma and sarcoma were the most common primary tumors. Similar features were n oted in the 14 patients with nonsinus calvarial metastases. Of the 13 dural sinus calvarial metastases, 11 involved the superior sagittal sinus, and 2 involved the transverse sinus. In nine patients, the involved sinus was re sected, and in four patients, the sinus was reconstituted after tumor remov al. Nine patients in the dural sinus calvarial metastases group received en bloc resection, and four received piecemeal resection. No operative deaths occurred. The overall median actuarial survival was 16.5 months. The survi val times of the two groups were comparable. In the group with dural sinus calvarial metastases, transient postoperative neurological deficits occurre d in two patients (15%), and a permanent deficit occurred in one patient (8 %). No patients in the group with nonsinus calvarial metastases experienced deficits after resection. Compared with piecemeal resection, en bloc resec tion was associated with significantly less blood loss. CONCLUSION: Complete extirpation of calvarial metastases that overlie or in vade a dural sinus can be achieved with only slightly more morbidity than c omplete removal of calvarial metastases that are located away from the sinu ses. En bloc resection is as safe as piecemeal resection and is more effect ive in limiting operative blood loss. The overall recurrence and survival r ates of patients with dural sinus calvarial metastases are similar to those of patients with calvarial metastases that do not involve the sinuses. The refore, involvement of a dural venous sinus should not discourage resection of calvarial metastases. In carefully selected cancer patients, surgery pr ovides effective palliation of symptomatic calvarial metastases that overli e or invade the venous sinuses.