J Neurooncol. 2026 Aug 4;179(1):26. doi: 10.1007/s11060-026-05724-y.
ABSTRACT
PURPOSE: Cerebral sinus vein thrombosis (SVT) is a feared complication of brain tumour surgery, especially in sinus adjacent locations. In the comprehensive treatment of brain metastases (BM) intraoperative radiotherapy (IORT) is recently being established as a safe alternative to postoperative adjuvant stereotactic radiosurgery (SRS). However, uncertainty of on the risk about SVT keeps surgeons reluctant to its use in sinus adjacent locations. Aim of this study is to investigate the risk of SVT in patients undergoing IORT compared to standard postoperative SRS.
METHODS: We performed a retrospective analysis of 166 patients undergoing resection for histologically confirmed BM, of which 71 (42.8%) received IORT and 95 (57.2%) postoperative SRS. Tumour location, proximity to major dural venous sinuses, presence of SVT on postoperative imaging, timing of postoperative imaging, and, in SRS patients, time from surgery to radiotherapy were analyzed.
RESULTS: Postoperative SVT occurred in 5 patients (3.0%). There was no significant difference in SVT rates in the IORT (n = 2, 2.8%) and SRS (n = 3, 3.2%) groups (p = 1.0). All SVT cases occurred in sinus-adjacent lesions and remained clinically asymptomatic. Time to postoperative imaging did not differ in the two treatment groups. Time to imaging and, for the SRS group, time to radiation therapy, did not differ between the thrombosis and non-thrombosis groups (Mann-Whitney U = 3289.5, Z = - 0.283, p = 0.777 and Mann-Whitney U = 100.0, p = 0.419 respectively).
CONCLUSION: IORT was not associated with increased risk for SVT compared to surgery with post-operative SRS.
PMID:42550406 | DOI:10.1007/s11060-026-05724-y