Awake salvage resection for local recurrence or radiation necrosis after stereotactic radiosurgery and radiotherapy for brain metastases

Local recurrence or radiation necrosis after stereotactic radiosurgery or stereotactic radiotherapy (SRS/SRT) for brain metastases often presents a surgical challenge because of unclear lesion boundaries and high risk in the case of lesions proximal to eloquent areas. A retrospective study at Nara Medical University (Kashihara, Japan) evaluated the feasibility and usefulness of awake surgery as salvage treatment for recurrent lesions after SRS/SRT for brain metastases. Ten patients undergoing 11 awake surgeries were included (mean age 69.2 ± 7.9 years; mean time from SRS/SRT 793 ± 615 days). All awake surgeries were successfully performed, with gross total resection in 8 patients. The pathological diagnosis was recurrence in 7 cases and radiation necrosis in 4. Postoperative neurological function was preserved in the majority of cases, although one patients experienced transient worsening of motor function during the final stage of resection. Local control was achieved in all except one cases, with no recurrence during long-term follow-up in selected patients. The authors conclude that awake surgery is a feasible and useful salvage strategy for failed brain metastases after SRS/SRT.