title: Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas.
abstract: BACKGROUND
  Cerebral metastases are not sharply delimitatable; therefore, microsurgical circumferential stripping of intracerebral metastases is often insufficient for preventing local tumor recurrence. Supramarginal resection significantly improves local tumor control but was suggested not to be suitable for metastases in eloquent brain areas. Therefore, we retrospectively analyzed a series of patients with cerebral metastases situated in eloquent areas for newly occurring neurologic deficits after supramarginal resection performed as awake surgery.
  
  
  METHODS
  A retrospective analysis was performed for all patients who underwent supramarginal resection for a cerebral metastasis performed as awake surgery between June 2011 and April 2012. All metastases were localized in eloquent brain areas. Pre- and postsurgical neurologic status was documented as well as data regarding the primary cancer and histopathologic data. Postoperative MRI within 72 h was scheduled routinely to verify complete resection.
  
  
  RESULTS
  A total of 19 patients underwent awake surgery for a cerebral metastasis in eloquent brain areas. Surgery was well tolerated in all patients. Neurologic symptoms improved in five patients after surgery. In three patients, neurologic deficits existing before surgery worsened. The postoperative median National Institute of Health Stroke Scale (NIHSS) score did not differ from the preoperative value.
  
  
  CONCLUSIONS
  Awake surgery is a feasible tool for metastases in eloquent areas, minimizing postoperative neurologic deficits and morbidity. Therefore, eloquently situated metastases may also be eligible for supramarginal resection. Further studies are needed in order to analyze the benefit of this method in achieving better tumor control.
authors.affiliation: Department for Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany. marcelalexander.kamp@med.uni-duesseldorf.de
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Kamp
authors.forename: Maxine
authors.initials: M
authors.lastname: Dibué
authors.forename: Lena
authors.initials: L
authors.lastname: Niemann
authors.forename: Dorothea C
authors.initials: DC
authors.lastname: Reichelt
authors.forename: Jörg
authors.initials: J
authors.lastname: Felsberg
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Andrea
authors.initials: A
authors.lastname: Szelényi
authors.forename: Marion
authors.initials: M
authors.lastname: Rapp
authors.forename: Michael
authors.initials: M
authors.lastname: Sabel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology