Management of unknown origin cerebral metastases

Aim: The present study attempts todetermine the steps for obtaining theetiological diagnosis of brain metastaseswith unknown origin.Material and methods: A total of 190patients with brain metastases diagnosed inthe Department of Neurosurgery inEmergency Hospital ”N. Oblu” Iasibetween 2007-2010 were included in thisstudy. The clinical characteristics andpathological features were analyzed.Results: There were 102 males and 88females with a M:F ratio of 1.15:1. Themedian age of patients was 47.07 years(range 31-77 years). Females patients wereolder (mean age 57.21 years) than malespatients (49.15 years). 154 patients (81.05%)had single brain metastasis, and 36 patients(18.95%) had more than two. The lesionswere supratentorial in 142 patients(74.73%), infratentorial in 18 (9.47%), andboth infratentorial and supratentorial in 30patients (15.78%). Surgical treatmentinvolved complete resection in 47.9% ofcases, subtotal resection in 26.8%, andbiopsy alone in the remainder (25.3%).Brain metastases originating in lung cancerrepresented the most common type(47.39%), followed by those from breastcancer (19.79%), then those from skin(melanoma) (8.33%), genitourinarycarcinoma (6.30%), and gastrointestinalcarcinoma (2.62%). In 16.31% of cases, theprimary tumor remained unknown, despiteextensive investigation.Conclusion: The primary cancer leadingto brain metastases can be detected eitherby obtaining a sample of tumoral tissuethrough a neurosurgical operation on theintracerebral tumor (total ablation orstereotactic biopsy) with histopathologicalexamination, or by additional tests of thewhole body. Taken into consideration theresults of our own study, the managementof the patients with brain metastases shouldinclude a thoracic CT scan oranteroposterior and lateral chest X-ray,clinical breast examination andmammography, abdominal ultrasoundexploration, and skin, kidney and prostateexamination. With the most sophisticatedmethods of diagnosis in approximately 16%of cases the origin of metastasis remainsunknown. The identification of the primarysite by the neuropathologist afterstereotactic biopsy would clearly beadvantageous