Medical and Surgical Complication Rates in Initial and Repeat Craniotomies in Patients with Brain Metastasis: A Single-Center Study

Introduction: There is a general concern that repeat craniotomies for intracranial tumors are associated with higher rates of complications. Although studies have examined outcomes after repeat surgery for gliomas, there are few studies that examine this in the context of brain metastases (BM), specifically. This study evaluates the complication risks between initial and repeat craniotomies in patients with BM.

Methods: Patients who underwent resection of a BM in a single academic center over a 20-year study period were retrospectively reviewed. Demographic, clinical, and outcome data were collected. Patients undergoing initial craniotomies and repeat craniotomies were grouped separately. Outcomes of interest included surgical and medical complications. A multivariate logistic regression was used for categorical outcome data.

Results: The study cohort comprised of 379 and 104 patients who underwent one craniotomy or two or more craniotomies, respectively. There were no differences in age and sex between the two groups. Those with repeat craniotomy had higher rates of prior radiation treatment to brain metastases (51.9% vs 22.2%, P< 0.0001), while those with initial craniotomy had higher rates of adjuvant postoperative radiation (64.5% vs 45.2%, P=0.0006). There were no differences in rates of medical complications by discharge and 30 days and no differences in rates of surgical complications by discharge and 30 days. There were no differences in rate of readmission by 30 days and mortality rate at 6-months postop. A multivariate logistic regression model including age, numbers of craniotomies, number of BM at surgery, presence of brain hemorrhage preop, systemic disease present, BM size, and extent of resection showed that only age (OR=1.034, P= 0.0425) was associated with any complication at discharge.

Conclusion : Patients undergoing multiple craniotomies for brain metastases have no differences in complication rates compared to patients undergoing an initial craniotomy. Repeat craniotomies may be as safe as initial craniotomies if best practices are implemented.