Don’t cry over spilled milk.

Cry over spilled tumor. Iatrogenic leptomeningeal disease (LMD) remains a big downside to upfront surgical resection of brain metastases, even when followed by post-operative radiation. This retrospective look at outcomes after upfront surgery and post-op radiosurgery aims to identify lesions that might have a tell for holding higher chances to develop LMD. Among 134 patients followed with serial imaging for a median of 13 months, there were three standouts associated with post-op LMD: breast histology (HR 3.2), cystic or hemorrhagic features (HR 2.3), or presence of multiple brain mets (HR 2.1). TBL: Pre-op radiosurgery prior to brain met resection is gaining favor in certain circles, and these characteristics may point to populations who especially benefit from such a strategy. | Press, Neurosurgery 2019