SURG-26: COMPLICATION PROFILE: COMPARING CRANIECTOMY AND CRANIOTOMY FOR POSTERIOR FOSSA METASTASES

INTRODUCTION: Surgeries for resection of posterior fossa metastases (PFM) may include suboccipital craniotomy or craniectomy, with or without foramen magnum decompression (FMD). The optimal surgical technique is yet to be defined. In this study, we retrospectively examined the association between surgical approach and the occurrence of post-operative complications. METHODS: This is a retrospective consecutive analysis of patients who underwent resection of newly diagnosed PFM between 2003 and 2014. Medical records and neuro-imaging studies were reviewed for preoperative and postoperative clinical features, tumor characteristics including volumetric studies, the surgical technique used and patient's outcome. RESULTS: Eighty-eight patients were included in the study. The mean age and KPS was 59.6 ± 11.2 years and 80.9 ± 13.1, respectively. Mean tumor and peritumoral edema volumes were 17.6 ± 8.9ml and 30 ± 16.3ml respectively. Craniectomy was performed in 54 cases (61.4%) and FMD in 47.7% of the cases. Four patients (4.5%) underwent urgent postoperative posterior fossa decompression or CSF diversion. Postoperative complications included 10 cases (11.9%) with postoperative CNS infection, 3 cases (3.6%) with CSF leak, 6 cases (7.1%) with wound dehiscence, and 12 cases (23.5%) with long term pseudomeningocele. The median hospital length of stay after the initial operative procedure was 4 days (2-149 days) and the perioperative mortality rate was 2.3%. Multivariate analysis that included patient's baseline characteristics, imaging study parameters and surgical approaches found that suboccipital craniectomy was associated with an overall increase in postoperative complications (p = 0.03, OR = 4.48, CI 95% 4-17.6). No correlation was demonstrated between patient baseline characteristics or surgical technique with the need for urgent postoperative posterior fossa decompression or CSF diversion. CONCLUSION: Suboccipital craniotomy may be associated with lower incidence of postoperative morbidity when compared with suboccipital craniectomy and should be considered as the preferred approach for the resection of PFM