25% of all brain tumors spread to the brain or cerebellum of the primary cancer disease in another organ of the body, called metastasis, is called metastatic brain tumors.
Approximately 20-30% of all brain metastases constitute cerebellum metastases. Especially lung, breast, stomach and intestines, urinary tract, skin and other muscle-derived cancers have the feature of spreading to the cerebellum. Approximately 40-50% of cerebellum metastases are solitary (nodule) lesions, while the other 50-60% tend to be mixed (cystic, solitary). Those with small solitary lesions around large cystic cerebellum tumors. It could be von Hippel-Lindau disease. Cerebellum metastases are a disease of advanced age. Since primary organ cancers of the body are generally seen in advanced ages, their spread to the brain is more common in older ages. Cerebellar metastases are less common in childhood.
Clinical complaints and findings of cerebellum metastases
Most of the cerebellum metastases are referred to the neurosurgery clinic due to cancer in the primary organ of the body (either operated or biopsied), thus knowing the primary disease. These patients are usually patients who are treated in combination with surgery, radiotherapy and chemotherapy by other departments, or who are treated alone, due to primary organ disease. Very rarely, they come to neurosurgery outpatient clinics or emergency services without knowing the primary disease of cerebellum metastases.
Complaints and findings
In these patients, the leading complaints are headache, nausea and vomiting, double vision, imbalance and dizziness due to increased intracranial pressure due to increased pressure in the cerebellum. Headaches are initially at night, but as the tumor grows, they become continuous during the day. Morning sickness is characteristically common in lesions of the cerebellum. After increased intracranial pressure, eye complaints such as double vision and sometimes blurred vision are evident. Increased pressure in the eyes (papilledema) is observed. 6th cranial nerve palsy due to increased intracranial pressure (CIBA) is seen in approximately 15% of these patients. Truncal (trunk) ataxia is common. Cerebellar coordination disorders, tremor, dysmetria are seen. Nystagmus is less common. Cerebellar fits is a rarer condition.
Diagnosis in cerebellum metastases
As in all cerebellum tumors, medicated brain Magnetig Resonance (MR) technique, one of the brain imaging methods, is a very important and reliable noninvasive test method in the diagnosis of these lesions. Apart from this, the medicated brain Computed Tomography (CT) technique provides additional additional information compared to the MR technique in showing whether there are calcifications in the lesion in some tumors such as ependymoma, cystic cerebellar astrocytomas. PET-CT provides very important information for investigating primary organ disease. In patients with such metastases, tumor markers from systemic laboratory tests provide very additional information. As a result, when a cerebellum metastasis is considered, their diagnosis is made very quickly, quickly and reliably with today’s advanced diagnostic methods. In those who are thought to have such a cerebellum metastasis, first of all, the patients should be evaluated quickly because of the risk of herniation of the tumor. It is necessary to plan the treatment options after the patient’s overall and systemic consideration is discussed from the oncological council (radiation oncologist, medical oncologist neurosurgeon) and after the patient’s survival is discussed well. Because cerebellum metastases, unfortunately, do not allow enough time for oncological treatment of patients like brain metastases. Because cerebellum metastases enter the brain herniation faster.
Treatment
1: Medical treatment
A: Chemotherapy
B. Radio therapy
1: Traditional radiotherapy
2:Sterotaxic radiotherapy
2:Surgical therapy
3 Combined therapy
A: Surgical therapy
B: Radiotherapy
A: Chemotherapy
In the surgical treatment of cerebellum metastases, many questions need to be answered while making the decision to operate. The primary organ disease is known and the decision for cerebrospinal surgery should be taken in patients with solitary single lesions, especially large (>3 cm) and those with a risk of brain herniation, those with good general systemic health and a survival of more than 3 months. However, surgical treatment decision should not be made for those whose general health condition is very poor and poor, and those whose survival is very short. If the histopathology of the lesion in the brain of unknown primary is unknown, surgical treatment should be decided. In such patients, those with confirmed post-operative cerebellum metastases should be taken to oncological treatment (radiotherapy and chemotherapy) after surgery. The main goal in the surgical treatment of cerebellum metastases is to completely remove the tumor. In completely removed cerebellum metastases, it should be given to oncological treatment after surgery.
In conclusion
Cerebellum metastases should be discussed in the preoperative oncological council. Cerebellar metastasis surgery is very lucky for the patients who are decided to have it. Because cerebellum diseases are not like brain diseases and unfortunately do not give the patient the opportunity to complete other alternative oncological treatments. Unfortunately, oncological treatments remain unfinished. Surgery is a life-saving option because patients die from metastasis in the cerebellum, not from their primary disease. In addition, today, in experienced hands, there is no smell in cerebellum metastasis surgeries, and this is quite parallel with the experience of the surgeon. Cerebellum anatomy is quite different from brain anatomy and requires a lot of experience. There has been no death from my cerebellum metastasis surgeries for the last 20 years. If all cerebellum metastases are successfully removed, the patient will survive the survival time of the primary disease without additional neurological deficits.
