• Yusuke Ikeuchi, Masamitsu Nishihara, Kohkichi Hosoda, Noriaki Ashida, Shunsuke Yamanishi, Hiroaki Nagashima, Kazuhiro Tanaka, Yoshihiro Muragaki, and Takashi Sasayama.
• Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
• World Neurosurg. 2024 Nov 24; 193: 903910903-910.

ObjectiveWe investigated whether air in the cisterns or ventricles on postoperative computed tomography (CT) (reflecting the opening of the cerebrospinal fluid spaces during surgery) is a predictor of classical or nodular leptomeningeal disease (LMD) after resection of brain metastases.MethodsWe retrospectively analyzed 73 patients who underwent gross total resection of brain metastases between 2012 and 2020. Patients with air in the cisterns or ventricles on postoperative day 1 CT were categorized into the air-positive group, whereas those without air in the cisterns or ventricles on postoperative day 1 CT were categorized into the air-negative group. The primary outcome was the occurrence of classical or nodular LMD (nLMD), which was assessed using survival analysis.ResultsThere were 15 (21%) patients in the air-positive group and 58 (79%) in the air-negative group. The air-positive group exhibited significantly more cerebellar and ventricular contact lesions than the air-negative group. The 4-year rate of classical or nLMD was significantly higher in the air-positive group than in the air-negative group (67% vs. 33%, P < 0.001). Multivariate analysis identified air in the cisterns or ventricles on postoperative CT as the only significant predictor of classical or nLMD (P < 0.001).ConclusionsPostoperative air in the cisterns or ventricles can predict early classical or nodular leptomeningeal disease.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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