Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis
Introduction: Cystic brain metastases (BMs) are often more challenging to treat than solid BMs. Stereotactic cyst aspiration for volume reduction followed by stereotactic radiosurgery (SRS) is an alternative treatment modality that may benefit patients with large cystic BMs not favorable for SRS alo...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000037 |
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| author | David R. Peters Alfredo Conti Marc Levivier Luis Schiappacasse Mohamed Faouzi Mioara Florentina Trandafirescu Constantin Tuleasca |
| author_facet | David R. Peters Alfredo Conti Marc Levivier Luis Schiappacasse Mohamed Faouzi Mioara Florentina Trandafirescu Constantin Tuleasca |
| author_sort | David R. Peters |
| collection | DOAJ |
| description | Introduction: Cystic brain metastases (BMs) are often more challenging to treat than solid BMs. Stereotactic cyst aspiration for volume reduction followed by stereotactic radiosurgery (SRS) is an alternative treatment modality that may benefit patients with large cystic BMs not favorable for SRS alone nor microsurgical resection. Research question: Here, we perform a systematic review and meta-analysis of stereotactic aspiration alone or reservoir (Ommaya) placement plus aspiration followed by SRS for cystic BMs. Material and methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 31−th, 2022. We retained 10 studies reporting 280 patients. Results: Overall rate of tumor control for combined treatment of Ommaya placement plus aspiration plus SRS was 81.2% (62.5–99.9%, p < 0.001) and for stereotactic aspiration plus SRS was 64.7% (46.1–83.3%, p < 0.001). Overall rate of further intervention for combined treatment of Ommaya placement plus aspiration plus SRS was 15.8% (p = 0.08) and for stereotactic aspiration plus SRS was 14.8% (5.3–24.4%, p = 0.002). Overall complication rate for combined treatment of Ommaya placement plus aspiration plus SRS was 12.8% (2.3–23.3%, p = 0.01) and for stereotactic aspiration plus SRS was 1.5% (p = 0.12). Discussion and conclusion: Combined treatment of Ommaya placement plus cyst aspiration plus SRS in cystic BMs yields better local control as compared to stereotactic aspiration plus SRS, with similar rate of further intervention between procedures. Aspiration of the cyst plus SRS should be considered for patients with cystic metastases not able to undergo open surgery or upfront SRS. |
| format | Article |
| id | doaj-art-93702de37deb4943b5e455d65ec584e3 |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-93702de37deb4943b5e455d65ec584e32025-01-29T05:02:46ZengElsevierBrain and Spine2772-52942025-01-015104184Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysisDavid R. Peters0Alfredo Conti1Marc Levivier2Luis Schiappacasse3Mohamed Faouzi4Mioara Florentina Trandafirescu5Constantin Tuleasca6Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA; Mayo Clinic, Rochester, MN, USA; Lausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, SwitzerlandDepartment of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, ItalyLausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), SwitzerlandLausanne University Hospital (CHUV), Radiation Oncology Department, Lausanne, SwitzerlandDivision of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, SwitzerlandUniversity of Medicine and Pharmacy “Gr. T. Popa”, Iasi, RomaniaLausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland; Corresponding author. University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM); Lausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Rue du Bugnon 44-46, BH-1011, Lausanne, Switzerland.Introduction: Cystic brain metastases (BMs) are often more challenging to treat than solid BMs. Stereotactic cyst aspiration for volume reduction followed by stereotactic radiosurgery (SRS) is an alternative treatment modality that may benefit patients with large cystic BMs not favorable for SRS alone nor microsurgical resection. Research question: Here, we perform a systematic review and meta-analysis of stereotactic aspiration alone or reservoir (Ommaya) placement plus aspiration followed by SRS for cystic BMs. Material and methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 31−th, 2022. We retained 10 studies reporting 280 patients. Results: Overall rate of tumor control for combined treatment of Ommaya placement plus aspiration plus SRS was 81.2% (62.5–99.9%, p < 0.001) and for stereotactic aspiration plus SRS was 64.7% (46.1–83.3%, p < 0.001). Overall rate of further intervention for combined treatment of Ommaya placement plus aspiration plus SRS was 15.8% (p = 0.08) and for stereotactic aspiration plus SRS was 14.8% (5.3–24.4%, p = 0.002). Overall complication rate for combined treatment of Ommaya placement plus aspiration plus SRS was 12.8% (2.3–23.3%, p = 0.01) and for stereotactic aspiration plus SRS was 1.5% (p = 0.12). Discussion and conclusion: Combined treatment of Ommaya placement plus cyst aspiration plus SRS in cystic BMs yields better local control as compared to stereotactic aspiration plus SRS, with similar rate of further intervention between procedures. Aspiration of the cyst plus SRS should be considered for patients with cystic metastases not able to undergo open surgery or upfront SRS.http://www.sciencedirect.com/science/article/pii/S2772529425000037Stereotactic radiosurgeryBrain metastasesCystic brain metastasesOmmaya reservoirStereotactic aspirationCyst aspiration |
| spellingShingle | David R. Peters Alfredo Conti Marc Levivier Luis Schiappacasse Mohamed Faouzi Mioara Florentina Trandafirescu Constantin Tuleasca Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis Brain and Spine Stereotactic radiosurgery Brain metastases Cystic brain metastases Ommaya reservoir Stereotactic aspiration Cyst aspiration |
| title | Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis |
| title_full | Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis |
| title_fullStr | Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis |
| title_full_unstemmed | Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis |
| title_short | Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis |
| title_sort | stereotactic aspiration alone or ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis a systematic review and meta analysis |
| topic | Stereotactic radiosurgery Brain metastases Cystic brain metastases Ommaya reservoir Stereotactic aspiration Cyst aspiration |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000037 |
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