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Background: Malignant melanomas frequently metastasize to the brain, but metastases in the cerebellum are underrepresented compared with metastases in the cerebrum. Methods: We established animal models by injecting intracardially in athymic nude fox1nu mice two human melanoma cell lines, originating from a cerebral metastasis (HM19) and a cerebellar metastasis (HM86). Results: Using magnetic resonance imaging (MRI), metastases were first detected after a mean of 34.5 days. Mean survival time was 59.6 days for the mice in the HM86 group and significantly shorter (43.7 days) for HM19-injected animals (p < 0.001). In the HM86 group, the first detectable metastasis was located in the cerebellum in 15/55 (29%) mice compared with none in the HM19 group (p < 0.001). At sacrifice, cerebellar metastases were found in 34/55 (63%) HM86- injected mice compared with 1/53 (2%) in the HM19-injected (p < 0.001) mice. At that time, all mice in both groups had detectable metastases in the cerebrum. Comparing macroscopic and histologic appearances of the brain metastases with their clinical counterparts, the cell line-based tumors had kept their original morphologic characteristics. Conclusions: The present work demonstrates that human brain-metastatic melanoma cells injected intracardially in mice had retained inherent characteristics also in reproducing interaction with subtle microenvironmental brain tissue compartment-specific features. The models offer new possibilities for investigating tumor- and host-associated factors involved in determining tissue specificity of brain metastasis.

Several studies acknowledge a higher risk of morbidity and mortality following intracranial meningioma surgery in the elderly, yet there is no consensus with regards to risk factors. Four prognostic scoring systems have been proposed. To evaluate their usefulness, we assess the very old meningioma patients in our neuro-oncological database according to the four methods, and correlate the findings with mortality and morbidity. We retrospectively calculated scores according to the Clinical-Radiological Grading System (CRGS), the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema grading system (SKALE), the Geriatric Scoring System (GSS) and the Charlson Comorbidity Index (CCI) from all patients aged 80–90 years who had primary surgery for intracranial meningiomas 2003–2013 (n = 51), and related our findings to morbidity and mortality. The mortality rates were 3.9 %, 5.9 % and 15.7 % at 30-days, 3-months and 1-year post-surgery. The rate of complications requiring surgery was 13.7 %, 5.9 % had evacuation of intracerebral hematomas and two patients (3.9 %) had surgery for intracranial infection/osteitis. 15.7 % of the patients were neurologically worsened on discharge. The patients with SKALE scores ≤ 8 had significantly increased mortality rates. The GSS, the CRGS and the CCI were not found to correlate with mortality. Retrospectively evaluating four proposed scoring systems, we find that the SKALE score reflects the mortality at 1 month and 1 year following primary surgery for intracranial meningiomas in our very old patients. It may represent a helpful adjunct to their preoperative assessment.

Brain metastases are the most common intracranial malignancies in adults and can originate from virtually any primary cancer. However, primary tumors may have variable propensities to metastasize to the brain. In absolute numbers, the most common primary tumor origins are lung, breast, melanoma, kidney and colorectal cancer, in that respective order, but when taking the relative incidence of primary tumor into account, malignant melanomas have the greatest propensity to disseminate to the brain. Overall, parenchymal metastases are located in cerebral hemispheres in 80%, cerebellum in 15% and brain stem 5%, a distribution that closely parallels the regional blood flows and blood volumes of the respective regions. However, we have demonstrated that melanomas are significantly underrepresented in the cerebellum (P

To study patient characteristics, prognostic factors and overall survival (OS) in a consecutive, surgical series of WHO grade III anaplastic astrocytomas (AA).Patients were identified from a prospective tumor database at Oslo University Hospital, Norway, and patients undergoing surgery for an AA from 2005-2012 were included. Patients' medical charts were retrospectively reviewed for data collection.A total of 99 adult patients with histologically verified AA were included. Median age was 52 years (20-81). Biopsy was conducted in 33 % and resection in 67 %. Adjuvant treatment with radiation therapy + temozolomide or radiation therapy only was given in 63 % and 26 %, respectively. The thirty-day mortality rate was 3 %. Median OS was 19 months (95 % CI 11-27 months). Age ≥ 65 years, KPS 70, biopsy as opposed to resection, and no adjuvant treatment were confirmed negative prognostic factors in multivariate analysis. For patients undergoing resection, presence of postoperative contrast-enhanced tumor, not volume of residual tumor, had significant impact on OS in adjusted analysis.Median OS following surgery was 19 months, though much variable outcome was observed among subgroups of AA (95 % CI 11-27 months). Age ≥65 years, KPS 70, biopsy as opposed to resection, and no adjuvant treatment were confirmed negative prognostic factors for OS.

The western world is facing an aging population and this will present challenges for the medical profession insofar as most studies regarding therapy has been undertaken in a younger population. In this chapter we present our experience with intracranial tumor surgery in patients aged more than 70 years old. We find that in our selected aging patients undergoing surgery the results are comparable to the results in younger patients given that the same adjuvant therapy is given. Hence, we believe that the indication for surgery should be based on the physiological age rather than the chronological age of the patient. This and the potential sources of surgical morbidity must always be weighted against the natural history of the disease.