A novel lesion severity index to predict 90-day postoperative survival in brain metastasis patients
By
Daniel C. Kreatsoulas
Joanne Kim
Mark Damante
Anna Orr
Joshua Wang
Joshua Vignolles-Jeong
Maxwell Gruber
Varun Shah
Nicholas Musgrave
Russell Lonser
Daniel Prevedello
J. Bradley Elder
Douglas A. Hardesty
June 11, 2025
Clinical Scorecard: A New Index for Assessing Lesion Severity to Forecast 90-Day Survival Rates Post-Surgery in Patients with Brain Metastases
At a Glance
Category Detail
Condition Brain metastases requiring craniotomy Key Mechanisms Assessment of lesion characteristics and patient factors to predict 90-day postoperative mortality Target Population Patients undergoing craniotomy for brain metastases Care Setting Tertiary referral center surgical setting
Key Highlights
Existing surgical risk scores (mFI-11, ASA, NSQIP) do not incorporate brain metastasis-specific factors. The Metastatic Brain Lesion Score (MBLS) was developed to predict 90-day mortality after brain metastasis surgery. Significant predictors include age, functional status, chronic pain medication use, lesion location, hemorrhage presence, and hydrocephalus. Guideline-Based Recommendations
Diagnosis
Identify brain metastases via clinical and imaging evaluation prior to craniotomy. Assess lesion characteristics including size, number, volume, location, hemorrhage, and proximity to critical brain structures. Management
Use MBLS to stratify surgical risk and guide patient selection for craniotomy. Consider patient functional status and comorbidities alongside lesion severity in surgical planning. Monitoring & Follow-up
Monitor postoperative course closely for 90-day survival outcomes. Evaluate neurological status and complications such as hydrocephalus post-surgery. Risks
Higher risk of 90-day mortality associated with advanced age (>65 years), reduced Karnofsky performance status, chronic pain medication use, deep brain nucleus/brainstem lesions, hemorrhagic metastases, and ventricular involvement. Patient & Prescribing Data
Patients undergoing craniotomy for brain metastases at a tertiary center
MBLS provides improved risk stratification over general surgical risk scores, aiding in personalized surgical decision-making.
Clinical Best Practices
Incorporate brain metastasis-specific factors into preoperative risk assessment using MBLS. Perform comprehensive chart review including cancer history, tumor characteristics, and functional status. Use multivariable logistic regression-derived scoring to inform prognosis and consent discussions. Validate risk scores in independent patient cohorts to ensure reliability. References
