{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:33:29Z","timestamp":1792172009960,"version":"4.4.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Surgical spillage has been one of the causative factors for the development of leptomeningeal seeding (LMS) after resection of brain metastases. In this paper, the authors' goal was to define the factors related to the development of LMS and to evaluate the difference according to tumor location.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively analyzed 242 patients who had undergone resection for brain metastases. The factors investigated included tumor location with proximity to the CSF pathway (that is, contacting, involved with, or separated from the CSF pathway), the method of resection, and the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 39 patients (16%) developed LMS at a median of 6.0 months (range 1\u201342 months) after resection. The risk of developing LMS was significantly higher in patients whose tumors were resected piecemeal than in those whose tumors were removed en bloc, with a hazard ratio (HR) of 4.08 (p &lt; 0.01). The incidence of LMS was significantly higher in patients in whom the CUSA was used, and the HR was 2.64 (p &lt; 0.01). The proximity of tumor to the CSF pathway in the involved group conferred an increased risk of LMS compared with the separated group (HR 11.36, p &lt; 0.01). The risk of piecemeal resection for LMS was significant only in involved lesions (p &lt; 0.01), and the use of the CUSA in both contact and involved lesions increased the incidence of LMS (p &lt; 0.01 and p &lt; 0.03, respectively).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The authors suggest that piecemeal resection using the CUSA should be limited because of the risk of postsurgical LMS, especially when the tumor is in contact with the CSF pathway.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.1.jns111560","type":"journal-article","created":{"date-parts":[[2012,2,17]],"date-time":"2012-02-17T14:58:04Z","timestamp":1329490684000},"page":"984-993","source":"Crossref","is-referenced-by-count":93,"title":["Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location with mode of resection"],"prefix":"10.3171","volume":"116","author":[{"given":"Jun Hyong","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Seoul National University College of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohee","family":"Kim","sequence":"additional","affiliation":[{"name":"Cancer Biostatistics Branch, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungnam","family":"Joo","sequence":"additional","affiliation":[{"name":"Cancer Biostatistics Branch, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heon","family":"Yoo","sequence":"additional","affiliation":[{"name":"Neuro-oncology Clinic, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Neuro-oncology Clinic, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hoon","family":"Shin","sequence":"additional","affiliation":[{"name":"Neuro-oncology Clinic, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho-Shin","family":"Gwak","sequence":"additional","affiliation":[{"name":"Neuro-oncology Clinic, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns111560","series-title":"J Neurooncol","first-page":"271","article-title":"Leptomeningeal metastases: a review of evaluation and treatment","volume":"37","author":"Chamberlain","year":"1998"},{"key":"b2-jns111560","series-title":"J Neurooncol","first-page":"245","article-title":"Current diagnosis and treatment of leptomeningeal metastasis","volume":"38","author":"DeAngelis","year":"1998"},{"key":"b3-jns111560","series-title":"Neurosurgery","first-page":"798","article-title":"The role of postoperative radiotherapy after resection of single brain metastases","volume":"24","author":"DeAngelis","year":"1989"},{"key":"b4-jns111560","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1727","article-title":"Management of solitary metastasis to the brain: the role of elective brain irradiation following complete surgical resection","volume":"6","author":"Dosoretz","year":"1980"},{"key":"b5-jns111560","series-title":"N Engl J Med","first-page":"1182","article-title":"Tumor angiogenesis: therapeutic implications","volume":"285","author":"Folkman","year":"1971"},{"key":"b6-jns111560","series-title":"J Surg Oncol","first-page":"191","article-title":"Inadvertent spread of cancer at surgery","volume":"53","author":"Fortner","year":"1993"},{"key":"b7-jns111560","series-title":"Ann Neurol","first-page":"51","article-title":"Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis","volume":"38","author":"Freilich","year":"1995"},{"key":"b8-jns111560","series-title":"Neurosurgery","first-page":"64","article-title":"Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children","volume":"30","author":"Grabb","year":"1992"},{"key":"b9-jns111560","series-title":"J Neurooncol","first-page":"33","article-title":"The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline","volume":"96","author":"Kalkanis","year":"2010"},{"key":"b10-jns111560","series-title":"Neurol Med Chir (Tokyo)","first-page":"591","article-title":"Follow-up study on metastatic cerebellar tumor surgery\u2014characteristic problems of surgical treatment","volume":"30","author":"Kitaoka","year":"1990"},{"key":"b11-jns111560","series-title":"JAMA","first-page":"512","article-title":"Grafting and traumatic dissemination of carcinoma in course of operations for malignant disease","volume":"60","author":"Mayo","year":"1913"},{"key":"b12-jns111560","series-title":"Oncology","first-page":"232","article-title":"Intradural spinal metastases in patients with posterior fossa brain metastases from various primary cancers","volume":"44","author":"Mirimanoff","year":"1987"},{"key":"b13-jns111560","series-title":"J Neurooncol","first-page":"215","article-title":"Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: a potentially preventable complication","volume":"32","author":"Norris","year":"1997"},{"key":"b14-jns111560","series-title":"Arch Neurol","first-page":"122","article-title":"Infiltration of the leptomeninges by systemic cancer. A clinical and pathologic study","volume":"30","author":"Olson","year":"1974"},{"key":"b15-jns111560","series-title":"JAMA","first-page":"1485","article-title":"Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial","volume":"280","author":"Patchell","year":"1998"},{"key":"b16-jns111560","series-title":"Cancer Res","first-page":"6168","article-title":"Intrathecal 4-hydroperoxycyclophosphamide: neurotoxicity, cerebrospinal fluid pharmacokinetics, and antitumor activity in a rabbit model of VX2 leptomeningeal carcinomatosis","volume":"52","author":"Phillips","year":"1992"},{"key":"b17-jns111560","series-title":"Br J Neurosurg","first-page":"486","article-title":"Tumour cell dispersion by the ultrasonic aspirator during brain tumour resection","volume":"13","author":"Preston","year":"1999"},{"key":"b18-jns111560","series-title":"Medicine (Baltimore)","first-page":"45","article-title":"Carcinomatous leptomeningitis in small cell lung cancer: a clinicopathologic review of the National Cancer Institute experience","volume":"61","author":"Rosen","year":"1982"},{"key":"b19-jns111560","series-title":"Cancer","first-page":"1700","article-title":"Leptomeningeal metastases from small cell lung carcinoma","volume":"104","author":"Seute","year":"2005"},{"key":"b20-jns111560","series-title":"J Neurooncol","first-page":"115","article-title":"Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery","volume":"67","author":"Siomin","year":"2004"},{"key":"b21-jns111560","series-title":"J Neurosurg","first-page":"248","article-title":"Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa","volume":"108","author":"Suki","year":"2008"},{"key":"b22-jns111560","series-title":"Neurosurgery","first-page":"664","article-title":"Comparative risk of leptomeningeal dissemination of cancer after surgery or stereotactic radiosurgery for a single supratentorial solid tumor metastasis","volume":"64","author":"Suki","year":"2009"},{"key":"b23-jns111560","series-title":"J Neurooncol","first-page":"85","article-title":"Leptomeningeal metastases from solid malignancy: a review","volume":"75","author":"Taillibert","year":"2005"},{"key":"b24-jns111560","series-title":"Br J Surg","first-page":"873","article-title":"Anastomotic recurrence in large bowel cancer","volume":"74","author":"Umpleby","year":"1987"},{"key":"b25-jns111560","series-title":"J Neurol Neurosurg Psychiatry","first-page":"225","article-title":"Leptomeningeal metastasis after surgical resection of brain metastases","volume":"66","author":"van der Ree","year":"1999"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p984.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p984.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p984.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T01:08:47Z","timestamp":1679879327000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p984.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,5]]},"references-count":25,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2012.1.jns111560","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,5]]}}}