Metastasis
- Cerebral
Metastasis
- Symptoms:
Signs of increased ICP, seizure, with or without focal neurologic deficit
- Etiology
- Adults
– Lung, breast, kidney, skin (melanoma)
- Children
– Neuroblastoma, rhabdomyosarcoma, and Wilm’s tumor
- Single
mets are most commonly breast, renal, and ovarian
- Multiple
mets are most commonly lung, melanoma, and colon
- Spontaneous
hemorrhage into tumor – renal cell, choriocarcinoma, and melanoma
- Brain
lesion is first sign of malignancy – Lung, GI, melanoma, pancreas, and
ovary
- Approximately
50% have no documented primary site
- Posterior
fossa mets frequently cause obstructive hydrocephalus
- Diagnosis:
Contrasted head CT shows circumscribed enhancing mass (usually at
gray-white junction) with surrounding edema
- Recommend:
MRI head with and without gad to R/O further disease not seen on head CT
- High
dose steroids for edema (decadron 10 mg IV q6)
- Load
patient with anticonvulsant (if supratentorial)
- Treatment:
- Single
mets benefit from surgical excision followed by XRT
- Multiple
mets generally receive XRT
- Gamma
knife good alternative to surgery
- Reasons
for surgical intervention: no diagnosis, single met, poorly
radiosensitive lesion, prior XRT, large symptomatic lesion, impending
herniation or hydrocephalus
- Overall,
median survival is 9 months
- In
selected patients with single lesions and no systemic disease, excision
my effect cure or long-term remission
- Carcinomatous
Meningitis
- Symptoms:
HA, change in mental status, neck stiffness, cranial nerve deficits,
radiculopathy in patient with a known malignancy
- Most
commonly seen with breast, lung, melanoma, and lymphoma
- Diagnosis:
Lumbar puncture cytology
- Enhancement
of meninges on MRI
- Treatment:
Intrathecal chemotherapy
- Often
require placement of intrathecal catheter (ventricular or lumbar) to
allow easier delivery of agent