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Acute intracranial hypertension management in metastatic brain tumor: A French national survey

Abstract : Background.-Brain metastases occur in 15-30% of cancer patients and their frequency has increased over time. They can cause intracranial hypertension, even in the absence of hydrocephalus. Emergency surgical management of brain metastasis-related intracranial hypertension is not guided by specific recommendations. Objective.-We aimed to make a French national survey of emergency management of intracranial hypertension without hydrocephalus in the context of cerebral metastasis. Methods.-A national online survey of French neurosurgeons from 16 centers was conducted, consisting of three clinical files, with multiple-choice questions on diagnostic and therapeutic management in different emergency situations. Results.-In young patients without any previously known primary cancer, acute intracranial hyper-tension due to a seemingly metastatic single brain tumor indicated emergency surgery for all those interviewed; 61% aimed at complete resection; brain MRI was mandatory for 74%. When a primary cancer was known, 74% of respondents were more likely to propose surgery if an oncologist confirmed the possibility of adjuvant treatment; 27% were more likely to operate on an emergency basis when resection was scheduled after multidisciplinary discussion, prior to acute degradation. Conclusion.-Currently, there is no consensus on the emergency management of intracranial hypertension in metastatic brain tumor patients. In case of previously known primary cancer, a discussion with the oncology team seems necessary, even in emergency. Decision criteria emerge from our literature review, but require analysis in further studies.
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E Mazerand, C. Gallet, J. Pallud, P. Menei, F. Bernard. Acute intracranial hypertension management in metastatic brain tumor: A French national survey. Neurochirurgie, Elsevier Masson, 2019, 65, pp.348 - 356. ⟨10.1016/j.neuchi.2019.07.003⟩. ⟨inserm-02912525⟩



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