{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:36:17Z","timestamp":1769729777356,"version":"3.49.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,11,25]]},"abstract":"\n BACKGROUND<\/jats:title>\n The management of cystic brain metastases remains challenging, with high recurrence rates following treatment with resection and\/or stereotactic radiosurgery (SRS). Tumor resection and adjuvant radiation provide superior outcomes in comparison to those for each therapy alone, but large cystic tumor en bloc removal is difficult. Cyst aspiration can be used to decrease the radiation target volume, enabling safer delivery of a therapeutic radiation dose with improved local tumor control. However, cysts can rapidly recur following aspiration. Herein, the authors present a case in which cyst aspiration, radiation, and resection were combined within a single procedure.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n During a single anesthesia episode, a 70-year-old female underwent stereotactic cyst aspiration, single-fraction SRS, and resection of a 3.7-cm cystic temporal lobe breast metastasis. The lesion volume exceeded 40 cm\n 3<\/jats:sup>\n before cyst aspiration, decreasing by 62.5% afterward.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Definitive management of large cystic brain metastases including aspiration, radiation, and resection is feasible under a single anesthesia session. This approach, compared to traditional management, could help minimize challenges associated with large cystic lesions, including recurrence and\/or radiation necrosis.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24357<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24357","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T13:04:55Z","timestamp":1732539895000},"source":"Crossref","is-referenced-by-count":0,"title":["Multimodal treatment paradigm for unstaged resection of a large cystic brain metastasis: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Ali","family":"Gharibi Loron","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin L.","family":"Webb","sequence":"additional","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry C.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"suppl","key":"bib1","series-title":"J Neurosurg","first-page":"128","article-title":"Gamma Knife surgery for brain metastases from lung cancer","volume":"102","author":"Pan","year":"2005","unstructured":"Pan HCSheehan JStroila MSteiner MSteiner L. Gamma Knife surgery for brain metastases from lung cancer. J Neurosurg. 2005;102(suppl):128-133."},{"issue":"2","key":"bib2","series-title":"J Neurosurg","first-page":"259","article-title":"Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis","volume":"109","author":"Franzin","year":"2008","unstructured":"Franzin AVimercati APicozzi P, et al. Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis. J Neurosurg. 2008;109(2):259-267."},{"issue":"1","key":"bib3","series-title":"Br J Neurosurg","first-page":"43","article-title":"Gamma Knife radiosurgery for cystic brain metastases","volume":"30","author":"Lee","year":"2016","unstructured":"Lee SROh JYKim SH. Gamma Knife radiosurgery for cystic brain metastases. Br J Neurosurg. 2016;30(1):43-48."},{"issue":"4","key":"bib4","series-title":"J Korean Neurosurg Soc","first-page":"360","article-title":"Gamma Knife radiosurgery after stereotactic aspiration for large cystic brain metastases","volume":"46","author":"Park","year":"2009","unstructured":"Park WHJang ISKim CJKwon DH. Gamma Knife radiosurgery after stereotactic aspiration for large cystic brain metastases. J Korean Neurosurg Soc. 2009;46(4):360-364."},{"issue":"2","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"343","article-title":"Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases","volume":"163","author":"Sadik","year":"2021","unstructured":"Sadik ZHAHanssens PEJVerheul JB, et al. Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases. Acta Neurochir (Wien). 2021;163(2):343-350."},{"issue":"suppl","key":"bib6","series-title":"J Neurosurg","first-page":"17","article-title":"Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component","volume":"117","author":"Higuchi","year":"2012","unstructured":"Higuchi FKawamoto SAbe YKim PUeki K. Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component. J Neurosurg. 2012;117(suppl):17-22."},{"key":"bib7","series-title":"Front Surg","first-page":"901674","article-title":"Case report: clinical and procedural implications of Ommaya reservoir implantation in cystic brain metastases followed by radiosurgery treatment","volume":"9","author":"Lv","year":"2022","unstructured":"Lv JWu ZWang KWang YYang SHan W. Case report: clinical and procedural implications of Ommaya reservoir implantation in cystic brain metastases followed by radiosurgery treatment. Front Surg. 2022;9:901674."},{"key":"bib8","series-title":"J Clin Neurosci","first-page":"199","article-title":"Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery","volume":"39","author":"Oshima","year":"2017","unstructured":"Oshima AKimura TAkabane AKawai K. Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery. J Clin Neurosci. 2017;39:199-202."},{"issue":"1","key":"bib9","series-title":"BMC Cancer","first-page":"332","article-title":"Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial","volume":"24","author":"Routman","year":"2024","unstructured":"Routman DMJusue-Torres IBrown PD, et al. Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial. BMC Cancer. 2024;24(1):332."},{"issue":"1","key":"bib10","series-title":"Brain Tumor Res Treat","first-page":"1","article-title":"Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration","volume":"3","author":"Kim","year":"2015","unstructured":"Kim MCheok SChung LK, et al. Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration. Brain Tumor Res Treat. 2015;3(1):1-7."},{"issue":"1","key":"bib11","series-title":"Oncol Lett","first-page":"343","article-title":"Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases","volume":"12","author":"Wang","year":"2016","unstructured":"Wang HQi SDou CJu HHe ZMa Q. Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases. Oncol Lett. 2016;12(1):343-347."},{"issue":"suppl","key":"bib12","series-title":"J Neurosurg","first-page":"79","article-title":"Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors","volume":"105","author":"Yamanaka","year":"2006","unstructured":"Yamanaka YShuto TKato Y, et al. Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors. J Neurosurg. 2006;105(suppl):79-81."},{"issue":"5","key":"bib13","series-title":"Neurosurgery","first-page":"632","article-title":"Hemorrhagic and cystic brain metastases are associated with an increased risk of leptomeningeal dissemination after surgical resection and adjuvant stereotactic radiosurgery","volume":"85","author":"Press","year":"2019","unstructured":"Press RHZhang CChowdhary M, et al. Hemorrhagic and cystic brain metastases are associated with an increased risk of leptomeningeal dissemination after surgical resection and adjuvant stereotactic radiosurgery. Neurosurgery. 2019;85(5):632-641."},{"issue":"4","key":"bib14","series-title":"Neurologist","first-page":"179","article-title":"Neoplastic meningitis","volume":"12","author":"Chamberlain","year":"2006","unstructured":"Chamberlain MC. Neoplastic meningitis. Neurologist. 2006;12(4):179-187."},{"issue":"4","key":"bib15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"713","article-title":"Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases","volume":"87","author":"Atalar","year":"2013","unstructured":"Atalar BModlin LAChoi CY, et al. Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. 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Cancers (Basel). 2022;14(17):4328."},{"issue":"1","key":"bib18","series-title":"Sci Rep","first-page":"4567","article-title":"Evaluation of the impact of pre-operative stereotactic radiotherapy on the acute changes in histopathologic and immune marker profiles of brain metastases","volume":"12","author":"Kotecha","year":"2022","unstructured":"Kotecha RTonse RMenendez MAR, et al. Evaluation of the impact of pre-operative stereotactic radiotherapy on the acute changes in histopathologic and immune marker profiles of brain metastases. Sci Rep. 2022;12(1):4567."},{"issue":"suppl","key":"bib1","series-title":"J Neurosurg","first-page":"128","article-title":"Gamma Knife surgery for brain metastases from lung cancer","volume":"102","author":"Pan","year":"2005","unstructured":"Pan HCSheehan JStroila MSteiner MSteiner L. Gamma Knife surgery for brain metastases from lung cancer. J Neurosurg. 2005;102(suppl):128-133."},{"issue":"2","key":"bib2","series-title":"J Neurosurg","first-page":"259","article-title":"Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis","volume":"109","author":"Franzin","year":"2008","unstructured":"Franzin AVimercati APicozzi P, et al. Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis. J Neurosurg. 2008;109(2):259-267."},{"issue":"1","key":"bib3","series-title":"Br J Neurosurg","first-page":"43","article-title":"Gamma Knife radiosurgery for cystic brain metastases","volume":"30","author":"Lee","year":"2016","unstructured":"Lee SROh JYKim SH. Gamma Knife radiosurgery for cystic brain metastases. Br J Neurosurg. 2016;30(1):43-48."},{"issue":"4","key":"bib4","series-title":"J Korean Neurosurg Soc","first-page":"360","article-title":"Gamma Knife radiosurgery after stereotactic aspiration for large cystic brain metastases","volume":"46","author":"Park","year":"2009","unstructured":"Park WHJang ISKim CJKwon DH. Gamma Knife radiosurgery after stereotactic aspiration for large cystic brain metastases. J Korean Neurosurg Soc. 2009;46(4):360-364."},{"issue":"2","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"343","article-title":"Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases","volume":"163","author":"Sadik","year":"2021","unstructured":"Sadik ZHAHanssens PEJVerheul JB, et al. Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases. Acta Neurochir (Wien). 2021;163(2):343-350."},{"issue":"suppl","key":"bib6","series-title":"J Neurosurg","first-page":"17","article-title":"Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component","volume":"117","author":"Higuchi","year":"2012","unstructured":"Higuchi FKawamoto SAbe YKim PUeki K. Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component. J Neurosurg. 2012;117(suppl):17-22."},{"key":"bib7","series-title":"Front Surg","first-page":"901674","article-title":"Case report: clinical and procedural implications of Ommaya reservoir implantation in cystic brain metastases followed by radiosurgery treatment","volume":"9","author":"Lv","year":"2022","unstructured":"Lv JWu ZWang KWang YYang SHan W. Case report: clinical and procedural implications of Ommaya reservoir implantation in cystic brain metastases followed by radiosurgery treatment. Front Surg. 2022;9:901674."},{"key":"bib8","series-title":"J Clin Neurosci","first-page":"199","article-title":"Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery","volume":"39","author":"Oshima","year":"2017","unstructured":"Oshima AKimura TAkabane AKawai K. Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery. J Clin Neurosci. 2017;39:199-202."},{"issue":"1","key":"bib9","series-title":"BMC Cancer","first-page":"332","article-title":"Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial","volume":"24","author":"Routman","year":"2024","unstructured":"Routman DMJusue-Torres IBrown PD, et al. Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial. BMC Cancer. 2024;24(1):332."},{"issue":"1","key":"bib10","series-title":"Brain Tumor Res Treat","first-page":"1","article-title":"Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration","volume":"3","author":"Kim","year":"2015","unstructured":"Kim MCheok SChung LK, et al. Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration. Brain Tumor Res Treat. 2015;3(1):1-7."},{"issue":"1","key":"bib11","series-title":"Oncol Lett","first-page":"343","article-title":"Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases","volume":"12","author":"Wang","year":"2016","unstructured":"Wang HQi SDou CJu HHe ZMa Q. Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases. Oncol Lett. 2016;12(1):343-347."},{"issue":"suppl","key":"bib12","series-title":"J Neurosurg","first-page":"79","article-title":"Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors","volume":"105","author":"Yamanaka","year":"2006","unstructured":"Yamanaka YShuto TKato Y, et al. Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors. J Neurosurg. 2006;105(suppl):79-81."},{"issue":"5","key":"bib13","series-title":"Neurosurgery","first-page":"632","article-title":"Hemorrhagic and cystic brain metastases are associated with an increased risk of leptomeningeal dissemination after surgical resection and adjuvant stereotactic radiosurgery","volume":"85","author":"Press","year":"2019","unstructured":"Press RHZhang CChowdhary M, et al. Hemorrhagic and cystic brain metastases are associated with an increased risk of leptomeningeal dissemination after surgical resection and adjuvant stereotactic radiosurgery. Neurosurgery. 2019;85(5):632-641."},{"issue":"4","key":"bib14","series-title":"Neurologist","first-page":"179","article-title":"Neoplastic meningitis","volume":"12","author":"Chamberlain","year":"2006","unstructured":"Chamberlain MC. Neoplastic meningitis. Neurologist. 2006;12(4):179-187."},{"issue":"4","key":"bib15","series-title":"Int J Radiat Oncol Biol Phys","first-page":"713","article-title":"Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases","volume":"87","author":"Atalar","year":"2013","unstructured":"Atalar BModlin LAChoi CY, et al. Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2013;87(4):713-718."},{"key":"bib16","series-title":"Front Neurol","first-page":"959","article-title":"Preoperative stereotactic radiosurgery for brain metastases","volume":"9","author":"Routman","year":"2018","unstructured":"Routman DMYan EVora S, et al. Preoperative stereotactic radiosurgery for brain metastases. Front Neurol. 2018;9:959."},{"issue":"17","key":"bib17","series-title":"Cancers (Basel)","first-page":"4328","article-title":"Neoadjuvant stereotactic radiotherapy for brain metastases: systematic review and meta-analysis of the literature and ongoing clinical trials","volume":"14","author":"Palmisciano","year":"2022","unstructured":"Palmisciano PFerini GKhan R, et al. Neoadjuvant stereotactic radiotherapy for brain metastases: systematic review and meta-analysis of the literature and ongoing clinical trials. Cancers (Basel). 2022;14(17):4328."},{"issue":"1","key":"bib18","series-title":"Sci Rep","first-page":"4567","article-title":"Evaluation of the impact of pre-operative stereotactic radiotherapy on the acute changes in histopathologic and immune marker profiles of brain metastases","volume":"12","author":"Kotecha","year":"2022","unstructured":"Kotecha RTonse RMenendez MAR, et al. Evaluation of the impact of pre-operative stereotactic radiotherapy on the acute changes in histopathologic and immune marker profiles of brain metastases. 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