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Association of cystic features with more rapid recovery of neurological deficits following resection of brain metastases
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DOI：10.3171/2025.7.JNS25241.png)
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Abstract
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OBJECTIVE Brain metastases can cause focal neurological deficits that significantly impact quality of life. While resection can lead to deficit recovery, it remains unclear how patient and tumor characteristics at presentation predict postoperative improvement. This retrospective cohort study aimed to examine the impact of cystic features on time to improvement of preoperative neurological deficits. METHODS Retrospective chart review was performed for adults who underwent resection for one or more brain metastases at a single institution from 2004 to 2022. Patient and tumor variables were compared between cystic and noncystic metastases using the Wilcoxon rank-sum test, Pearson's chi-square test, or Fisher's exact test. Local and distant progression-free survival and time to deficit resolution were compared using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS In total, 464 tumors from 444 patients were included, with median clinical and imaging follow-up durations of 9.7 and 6.6 months, respectively. Cystic features were present in 134 tumors and absent in 330. While cystic and non-cystic metastases had similar rates of deficit recovery, cystic metastases had a shorter time to deficit recovery (median 1 month, 95% CI 0-4) compared to noncystic (median 8 months, 95% CI 5-23, p = 0.012, log-rank test), with recovery plateauing at 6 months and 2 years, respectively. There were no differences in progression-free survival. Older age (HR 0.98, 95% CI 0.96-0.99, p = 0.005) and tumor in an eloquent cortex (HR 0.62, 95% CI 0.39-0.98, p = 0.041) were associated with slower neurological recovery, while cystic features (HR 1.50, 95% CI 1.02-2.20, p = 0.039) and adjuvant radiotherapy (HR 1.59, 95% CI 1.05-2.42, p = 0.029) were associated with faster recovery. CONCLUSIONS Patients with cystic brain metastases experience quicker resolution of preoperative neurological deficits after resection but have similar rates of deficit recovery. Older age and tumor presence in eloquent cortex were associated with slower deficit improvement, while cystic features and adjuvant radiotherapy were associated with faster improvement.
Keywords:
brain metastases
neurological deficit
cystic
oncology
tumor
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