Frontal Metastasis: Principles of Resection

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Let's discuss resection of the large frontal metastasis. This is a 32 year old female who presented with progressive headaches. She was recently diagnosed with breast cancer. She unfortunately was found to harbor, a large lesion in the right frontal area associated with significant amount of edema consistent with a metastatic tumor. She underwent a right frontal craniotomy. You can see the surface of the tumor reaching the pia. I isolated the mass via cordectomy. The cap of the brain over the tumor has to be gently mobilized, so that the margins of the mass are clearly identified. I usually attempt to avoid the temptation to de-bulk the metastasis. I stay along the margins of the mass and try to remove the tumor in one piece and block. Entering the mass early without its circumferential disconnection can lead to significant bleeding and obscuration of their surgical planes. Obviously, one has to see exactly on the surface of the tumor. To assure goals to remove the mass. Cottonoid patties may be used to maintain the, the section planes, as one moves from one area of the tumor to the other. Here's the edematous surrounding brain. Over the capsule, the tumor that is being exposed. Rolling the tumor side to side to find the section planes over the capsule of the tumor. Here, you can see the tumor is very well-defined as expected. Now it's being removed and blocked. I inspect the operative cavity to make sure no residual tumor is overlooked. And pure water irrigation is used to clear the debris and the postoperative scan revealed gross totally removed mass, with resolution of most of the edema. Thank you.

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