Early postoperative seizures (EPS) are a common complication of brain tumour surgery. This paper investigates risk factors, management and clinical relevance of EPS. We retrospectively analysed the occurrence of EPS, clinical and laboratory parameters, imaging and histopathological findings in a cohort of 679 consecutive patients who underwent craniotomies for intracranial tumours between 2015 and 2017. EPS were observed in 34/679 cases (5.1%), with 14 suffering at least one generalized seizure. Patients with EPS had a worse postoperative Karnofsky performance index (KPI; with EPS, KPI < 70 vs. 70–100: 11/108, 10.2% vs. 23/571, 4.0%; p = 0.007). Preoperative seizure history was a predictor for EPS (none vs. 1 vs. ≥ 2 seizures: p = 0.037). Meningioma patients had the highest EPS incidence (10.1%, p < 0.001). Cranial imaging identified a plausible cause in most cases (78.8%). In 20.6%, EPS were associated with a persisting new neurological deficit that could not otherwise be explained. 34.6% of the EPS patients had recurrent seizures within one year. EPS require an emergency work-up. Multiple EPS and recurrent seizures are frequent, which indicates that EPS may also reflect a more chronic condition i.e. epilepsy. EPS are often associated with persisting neurological worsening.

Purpose: To better define the role of surgery, we investigated survival and functional outcomes in patients with multiple brain metastases. Methods: Pertinent clinical and radiological data of 131 consecutive patients (156 surgeries) were analyzed retrospectively. Results: Surgical indications included mass effect (84.6%) and need for tissue acquisition (44.9%, for molecularly informed treatment: 10 patients). Major (i.e. CTCAE grade 3–5) neurological, surgical and medical complication were observed in 6 (3.8%), 12 (7.7%), and 12 (7.7%) surgical cases. Median preoperative and discharge KPS were 80% (IQF: 60–90%). Median overall survival (mOS) was 7.4 months. However, estimated 1 and 2 year overall survival rates were 35.6% and 25.1%, respectively. Survival was dismal (i.e. mOS ≤ 2.5 months) in patients who had no postoperative radio- and systemic therapy, or who incurred major complications. Multivariate analysis with all parameters significantly correlated with survival as univariate parameters revealed female sex, oligometastases, no major new/worsened neurological deficits, and postoperative radio- and systemic therapy as independent positive prognostic parameters. Univariate positive prognostic parameters also included histology (best survival in breast cancer patients) and less than median (0.28 cm³) residual tumor load. Conclusions: Surgery is a reasonable therapeutic option in many patients with multiple brain metastases. Operations should primarily aim at reducing mass effect thereby preserving the patients’ functional health status which will allow for further local (radiation) and systemic therapy. Surgery for the acquisition of metastatic tissue (more recently for molecularly informed treatment) is another important surgical indication. Cytoreductive surgery may also carry a survival benefit by itself.

We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI 12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.

Surgery for singular brain metastases (BM) aims to improve survival by providing control of CNS disease. This concept may need to be refined against the background of recent advances in medical and radiation oncology. In particular there is a debate about the prognostic role of residual tumor. Does extent of resection influence overall- and cerebral progression-free-survival as well as functional outcome? This retrospective series comprised 202 patients with single BM who underwent surgery 2015–2023. All patients underwent pre- and postoperative MR imaging. Surgical indications included a tumor too large for radiosurgery (≥15.0 cm³; 42.5 %) and tissue acquisition for molecular analyses for potential therapeutic targets (21.8 %). Extent of resection was categorized as incomplete (8.4 %), questionably complete (22.3 %), and complete (69.3 %). Median residual tumor volume was only 0.12 cm³ (IQR 0.04–0.35). Complete resection was not correlated with better overall (OS) or CNS progression free survival. Complication rates and postoperative KPS did not vary significantly with resection category. Postoperative MRI revealed two cases with unilateral sigmoid sinus thrombosis in asymptomatic patients (cf. 11/16 [69.0 %] complications requiring treatment in symptomatic patients). We recorded 6.2 % major (CTCAE III-V) surgical, 5.3 % neurological, and 7.2 % medical complications. Postoperative treatment and major complications were prominent prognostic factors for OS. Small tumor remnants may have limited impact on survival. In the era of targeted therapies tissue acquisition for molecular analysis is an increasingly important indication for BM surgery.

Background/Objectives: Episodic memory impairment is common in patients with intracranial tumors and has significant implications for clinical management. Memory is often treated as a unitary construct, and parameter-specific patterns and perioperative changes remain poorly understood. This study aimed to examine different memory parameters, their temporal dynamics, and clinical predictors of impairment. Methods: This observational study included 76 patients undergoing resection of supratentorial tumors, assessed preoperatively and at one week and three months postoperatively. Episodic memory was evaluated using a standardized word-list learning paradigm, yielding measures of immediate recall, delayed recall, and recognition. Performance was classified using age-adjusted z-scores, and relevant intraindividual changes were examined. Risk factors for impairment were analyzed using logistic regression. Results: Long-term memory measures were more frequently impaired than immediate recall across all time points. Impairment rates increased markedly one week after surgery to as high as 46.5% but returned to baseline levels at three months; however, individual trajectories were heterogeneous. Preoperative impairment was associated with lower functional status. Postoperative memory deficits were strongly associated with preoperative impairment, with older age being additionally associated with transient deficits. Conclusions: Memory impairment after brain tumor surgery is dynamic and parameter-specific, with long-term memory particularly vulnerable. Predictor findings are exploratory given limited event numbers and substantial cohort heterogeneity. Although deficits are often transient, high interindividual variability exists, underscoring the need for individualized risk stratification and neuropsychological care. Increased attention should be paid to the vulnerable acute postoperative period, as intact short-term memory may mask impairments.

The vulnerability towards disease but also treatment in elderly patients has been referred to as frailty and can be measured using frailty indices, which assess functional health and comorbidities. Frailty has been shown to correlate with survival and functional outcomes in brain tumor patients. Does frailty, assessed by the 11-item modified Frailty Index (mFI-11), provide useful prognostic information in elderly patients undergoing brain metastasis surgery? A retrospective analysis of 139 patients aged ≥60 years who underwent brain metastasis resection (2015–2019) was conducted. Frailty was assessed using the mFI-11. Increasing frailty correlated with poorer median overall survival (mFI 0: 13.8 months [95 %-CI: 8.7–18.9] vs. mFI 1–2l: 8.7 [5.8–11.6] vs. mFI≥3: 2.8 [0.9–4.6], p = 0.001) and functional outcome (postoperative KPS 80–100 %, mFI 0: 27/36 [75.0 %] vs. mFI 1–2: 44/64 [68.8 %] vs. mFI≥3: 13/38 [34.2 %], p < 0.001). Age was less prognostic. In the multivariate analyses, mFI-11 and age were not independently predictive, while KPS was. Frailty was not associated with major complications. While frailty correlates with outcome, functional health rather than comorbidities and age is prognostic. The mFI-11's predictive ability may be largely due to its inclusion of a functional health assessment. Functional health (KPS) is a much stronger predictor of survival and functional outcome in the elderly than the presence of comorbidities and age, i.e. age per se and comorbidities without impact on the patient's functional health status (i.e. well-treated) should not deter from surgery. Frailty is not a predictor of complications.