Metastatic tumour of colorectal cancer in vermis cerebelli. Neurosurgical management

Synchronous metastases of colorectal cancer appear in app. 15% of patients. The most common location of the metastases are liver and lungs. Brain metastases are rare and appear in less than 5% of cases [1–3], typically located in the frontoparietal region and posterior fossa, especially in the cerebellar hemisphere. Colorectal cancer metastases in cerebellar vermis are very rare. The metastatic focuses can appear at any time after initial diagnosis of the primary tumour (synchronous and metachronous metastases), as well as after operation and ileus resection, but usually they appear in the late stage of disease. The brain metastasis decreases the life expectancy [1, 2, 4–7]. Early diagnosis and management of colorectal cancer increases the survival rate. The management after diagnosis of brain metastasis using only radiotherapy (whole brain radiotherapy – WBRT) offers a few months of life. Surgical therapy of the brain metastasis with adjuvant therapy may greatly increase the life expectancy [1, 8–10]. Metastatic organ dissemination and multiple brain metastases create poor perspectives.
Singular metastatic brain tumour in correlation with negative metastatic dissemination to other organs in the diagnostic process vastly improves the expectations and effectiveness of oncological therapy. Surgical treatment of a singular metastatic tumour located in the cerebellar vermis creates much better perspectives than the palliative scheme of management only. A ventriculo-peritoneal valve (shunt) does not prevent the growth of the metastatic focus resulting in brainstem compression. This treatment only affects ventricular enlargement. In many cases patients qualified for brain surgery require special management due to artificial stoma because the surgical procedure is usually performed in a sitting position.
Patients admitted to the Neurosurgical Department due to metastatic tumour in the posterior fossa have a variety of neurological symptoms. They depend on the localization-cerebellar hemisphere or vermis. If the metastatic tumour is located in the vermis, we can also observe the symptoms of hydrocephalus caused by pressuring the Sylvian aqueduct (Figures 1–3). Singular metastatic tumour should always be removed even if it is difficult to approach, i.e. vermal metastatic tumour. Ventriculo-peritoneal shunt should not be considered as a first option due to brainstem pressure and the possible occurrence of rapid local pressure symptoms. The operation is...


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