Monday, April 15
7:00 am - 9:00 am
107 Brain Metastases 2.0: Expert Management Strategies and Challenging Cases
Moderator(s): Steven N. Kalkanis, MD, FAANS
Panelist(s): Andrew J. Fabiano, MD, FAANS; Brian Vala Nahed, MD, FAANS ; Jeffrey J. Olson, MD, FAANS; Claudio G. Yampolsky, MD, IFAANS (Argentina)
Brain metastases (BM) are commonly treated as a part of a general neurosurgical practice.
Major changes in the management of brain metastases have occurred in the past decade.
This course will cover the management of brain metastases including:
1. Stereotactic Radiosurgery (SR)- Neo-Adjuvant SR, SR of brainstem metastases, Surgical cavity SR, Volumetric rather than lesion number approach to SR, Multi-session SR for large metastases.
2. Post-SR Metastases - Adverse Radiation Effect (ARE) vs. Tumor Progression Neuroimaging (ASL, PWI, PET), Pathophysiology of ARE, Laser-Interstitial Thermal Therapy (LITT)for ARE, Bevacizumab for ARE.
3. Surgical Resection of BM from Eloquent Cortex - Use of fMRI and DTI as adjuncts to the surgical resection of brain metastases.
4. Targeted Therapy - Updates on immune therapies that cross the blood-brain barrier including a summary of the current literature supporting immune therapies as a primary management strategy for BM. Discussion on the role of immune therapies in the BM treatment algorithm including successful and unsuccessful case presentations.
5. Interactive Case Presentations - Challenging and controversial BM case presentations with an "ask the audience" session to interactively discuss different management strategies.
- Describe advanced management strategies for Brain Metastases including resection from eloquent cortex, stereotactic radiosurgery, and immune therapy.
- Describe complex stereotactic radiosurgical planning for large metastases, brainstem metastases, and cavities before and after resection.
- Diagnose and manage post-stereotactic radiosurgery brain metastases. Describe the advantages and shortcomings of neuroimaging techniques.
- Develop an understanding of the role LITT and bevacizumab has in the treatment of post-SR brain metastases.
- Describe the current literature on the role of immune therapy as a primary treatment for brain metastases. Discuss current treatment algorithms for BM of various primary tumor types that incorporate immune therapies.