Objective:

To evaluate the association of intracranial lesion number with survival after surgical treatment, explore the contribution of operative completeness and tumor biology to outcomes, and develop a Dominant Lesion Surgery Score (DLSS) for perioperative risk stratification, emphasizing the role of tumor biology.

Key Findings:

• Intracranial lesion number alone is not a sufficient predictor of survival post-surgery, highlighting the need for comprehensive assessment.
• Operative completeness and tumor biology significantly influence patient outcomes, underscoring their importance in treatment planning.
• The Dominant Lesion Surgery Score (DLSS) was developed for better perioperative risk stratification, providing a valuable tool for clinicians.

Interpretation:

The study highlights the need for individualized treatment strategies that consider dominant lesions and patient-specific factors, rather than relying solely on lesion count, reinforcing the importance of a tailored approach.

Limitations:

• Retrospective nature may introduce selection bias.
• Single-center study limits generalizability of findings.
• Potential variability in treatment protocols over the 20-year study period.
• Confounding factors may affect outcomes in retrospective studies.

Conclusion:

The DLSS provides a quantitative framework for assessing perioperative risk in patients undergoing dominant lesion resection, emphasizing the importance of tailored surgical decision-making.