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BACKGROUND: While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuroimaging and spatial modeling analytics have facilitated further exploration into this field. METHODS: A systematic electronic database search for studies analyzing the distribution of brain metastases (BMs) from any primary systematic cancer published between January 1990 and July 2020 was conducted using PRISMA guidelines. RESULTS: Two authors independently reviewed 1957 abstracts, 46 of which underwent full-text analysis. A third author arbitrated both lists; 13 studies met inclusion/exclusion criteria. All were retrospective single- or multi-institution database reviews analyzing over 8227 BMs from 2599 patients with breast (8 studies), lung (7 studies), melanoma (5 studies), gastrointestinal (4 studies), renal (3 studies), and prostate (1 study) cancers. Breast, lung, and colorectal cancers tended to metastasize to more posterior/caudal topographic and vascular neuroanatomical regions, particularly the cerebellum, with notable differences based on subtype and receptor expression. HER-2-positive breast cancers were less likely to arise in the frontal lobes or subcortical region, while ER-positive and PR-positive breast metastases were less likely to arise in the occipital lobe or cerebellum. BM from lung adenocarcinoma tended to arise in the frontal lobes and squamous cell carcinoma in the cerebellum. Melanoma metastasized more to the frontal and temporal lobes. CONCLUSION: The observed topographical distribution of BM likely develops based on primary cancer type, molecular subtype, and genetic profile. Further studies analyzing this association and relationships to vascular distribution are merited to potentially improve patient treatment and outcomes.

Glioblastoma multiforme (GBM) is the most common primary brain cancer. Even with aggressive combination therapy, the median life expectancy for patients with GBM remains approximately 14 months. In order to improve the outcomes of patients with GBM, the development of newer treatments is critical. The concept of using the immune system as a therapeutic option has been suggested for several decades; by harnessing the body's adaptive immune mechanisms, immunotherapy could provide a durable and targeted treatment against cancer. However, many cancers, including GBM, have developed mechanisms that protect tumor cells from being recognized and eliminated by the immune system. For new immunotherapeutic regimens to be successful, overcoming immunosuppression via immune checkpoint signaling should be taken into consideration.

This article, published in the Journal of Neurological Surgery, explores the impact of endoscopic skull base surgery (ESBS) on sleep quality and cognitive function. The study conducted a retrospective cohort analysis of patients who underwent ESBS at an academic center. Patient-reported outcome measures were used to assess sleep quality and cognitive function before and after surgery. The results showed that patient-reported sleep quality worsened in the immediate postoperative period but improved over time. Cognitive function did not exhibit significant differences. The study suggests that factors such as anesthesia, hospitalization, and disrupted sleep patterns may contribute to sleep disturbance following ESBS. The findings have practical implications for preoperative counseling and managing patient expectations. [Extracted from the article]

This article discusses the incidence and natural history of residual pituitary neuroendocrine tumors (PitNETs) following endoscopic endonasal transsphenoidal surgery (ETSS). The study, conducted at the University of Washington, included 878 patients who underwent ETSS for resection of PitNETs between 2011 and 2023. Of these patients, 12.5% resulted in subtotal resection. The most common locations of residual tumor were the cavernous sinus and suprasellar compartment. Subsequent tumor progression was common, highlighting the need for long-term follow-up in cases of subtotal resection. [Extracted from the article]

This article compares the surgical outcomes of craniotomy and endoscopic endonasal transsphenoidal surgery (ETSS) in patients with adult-onset craniopharyngioma. Craniopharyngiomas are benign tumors that can cause endocrinopathies and visual deficits. The study found that the ETSS approach had a higher likelihood of achieving gross total resection and a lower likelihood of postoperative tumor recurrence compared to craniotomy. Patients undergoing ETSS were also less likely to experience deep venous thrombosis/pulmonary embolism and postoperative infections, but more likely to develop postoperative cerebrospinal fluid leakage. The rates of postoperative visual improvement and endocrinopathies were not significantly different between the two groups. [Extracted from the article]

This article discusses the clinical and radiographic characteristics, as well as the postoperative outcomes, of a combined endoscopic and transcranial approach for giant pituitary neuroendocrine tumors (PitNETs). The study, conducted at the University of Washington between 2011 and 2022, included 13 patients who underwent the combined approach. The results showed that the combined approach allowed for enhanced visualization and improved working angles, increasing the likelihood of achieving gross total resection. However, residual tumor in the cavernous sinus or adherent to critical neurovascular structures often limited complete resection. Complications of the combined approach included CSF leak, vasospasm, meningitis, hemorrhage, and hydrocephalus. Some patients required readmission within 30 days, and recurrence/progression occurred in a portion of the patients. One patient died due to extensive vasospasm and stroke. Overall, the combined approach shows promise for the resection of giant pituitary adenomas, but further research is needed to optimize outcomes. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the association between smoking cessation and perioperative complications in patients undergoing endoscopic endonasal resection of pituitary neuroendocrine tumors (PitNETs). The study, conducted at the University of Washington, involved a retrospective cohort of 764 patients. The results showed that smoking cessation equilibrated the risk of perioperative complications compared to never smokers. The authors suggest that optimizing modifiable risk factors, such as smoking cessation, may improve surgical outcomes in nonemergency surgeries. Further research involving multiple institutions is recommended to investigate the impact of active smoking on perioperative outcomes. [Extracted from the article]

This article discusses a study on silent corticotroph pituitary neuroendocrine tumors (SC PitNETs), which are a subset of nonfunctional pituitary tumors. The study aimed to evaluate the impact of multi-hormonal staining on the biological and clinical behavior of these tumors. The researchers analyzed data from 1,475 patients who underwent surgery for PitNETs at two universities between 2011 and 2023. They found that tumors with multi-hormonal staining had better radiographic and clinical outcomes compared to those with ACTH-only staining. The study suggests that the diverse clinical behavior of SC PitNETs may be influenced by the presence of multiple anterior pituitary hormones. Further research is needed to understand the effect of hormone staining on clinical outcomes. [Extracted from the article]

This article discusses the surgical outcomes of different types of prolactinomas, including silent, weakly secreting, and functional tumors. The study, conducted at the University of Washington, analyzed data from 282 patients who underwent surgical resection for prolactinomas between 2011 and 2023. The results showed that radiographic gross total resection was achieved in the majority of cases, with higher rates in silent prolactinomas compared to weakly secreting and functional tumors. Biochemical remission of functional prolactinomas occurred at lower rates, indicating the potential need for additional surgical, radiosurgical, or medical therapy. [Extracted from the article]

This article discusses the clinical, radiographic, and surgical outcomes of silent Tpit+ pituitary neuroendocrine tumors (PitNETs). The current diagnosis of PitNETs is based on immunohistochemical staining of specific transcription factors. Silent corticotroph (SC) PitNETs, which do not express anterior pituitary hormones, often exhibit more aggressive behavior. The study evaluated a multicenter surgical series of silent Tpit+ PitNETs and compared them to tumors with multilineage transcription factor expression. The results showed that single lineage Tpit+ tumors had more aggressive radiographic features and a higher rate of recurrence/progression compared to multi-lineage Tpit+ tumors. Further multi-disciplinary studies are needed to understand this association. [Extracted from the article]