由于新技术和手术概念的引入，显微神经外科技术在过去几年中取得了很大的进步。为了在新的全身和局部治疗方案时代重新评估显微神经外科手术在脑转移瘤（BM）切除术中的作用，需要重新评估其安全性。本研究的目的是根据大型现代显微神经外科系列中显微神经外科 BM 切除后的系统、全面且可靠、可重复的分级系统，分析不良事件 (AE) 的发生率，特别强调解剖位置。前瞻性收集 BM 病例对2013年至2022年期间的切除进行回顾性分析。 AE 的数量定义为根据 Clavien-Dindo 等级 (CDG) 与预期术后过程的任何偏差。使用单变量和多变量 Logistic 回归和生存分析来分析患者、手术和病变特征，包括确切的肿瘤解剖位置，以确定 AE 的预测因素。我们确定了 664 名符合条件的患者，肺癌是最常见的原发肿瘤（44% ），其次是黑色素瘤（25%）和乳腺癌（11%）。 29 名患者 (4%) 仅接受了活检，而 637 名患者 (96%) 则切除了 BM。出院时 AE 的总体发生率为 8%。然而，仅 1.9% (n = 12) 的病例发生严重 AE（≥CDG 3a；需要在局部/全身麻醉或 ICU 治疗下进行手术干预），围手术期死亡率为 0.6% (n = 4)。幕下肿瘤位置（OR 5.46，95% 2.31-13.8，p = .001）、再次手术（OR 2.31，95% 1.07-4.81，p = .033）和中心区域肿瘤位置（OR 3.03，95% 1.03-8.60）在主要 AE（CDG ≥ 2 或新的神经功能缺损）的多变量分析中显示出显着的预测因子。与凸面病变相比，深部幕上肿瘤和中央区域肿瘤均未与更多主要 AE 相关。就安全性而言，现代显微神经外科切除术可被认为是 BM 治疗的绝佳选择，因为即使在雄辩中，主要 AE 的总体发生率也非常罕见。和深部病变。© 2023。作者。

Microneurosurgical techniques have greatly improved over the past years due to the introduction of new technology and surgical concepts. To reevaluate the role of micro-neurosurgery in brain metastases (BM) resection in the era of new systemic and local treatment options, its safety profile needs to be reassessed. The aim of this study was to analyze the rate of adverse events (AEs) according to a systematic, comprehensive and reliably reproducible grading system after microneurosurgical BM resection in a large and modern microneurosurgical series with special emphasis on anatomical location.Prospectively collected cases of BM resection between 2013 and 2022 were retrospectively analyzed. Number of AEs, defined as any deviations from the expected postoperative course according to Clavien-Dindo-Grade (CDG) were evaluated. Patient, surgical, and lesion characteristics, including exact anatomic tumor locations, were analyzed using uni- and multivariate logistic regression and survival analysis to identify predictive factors for AEs.We identified 664 eligible patients with lung cancer being the most common primary tumor (44%), followed by melanoma (25%) and breast cancer (11%). 29 patients (4%) underwent biopsy only whereas BM were resected in 637 (96%) of cases. The overall rate of AEs was 8% at discharge. However, severe AEs (≥ CDG 3a; requiring surgical intervention under local/general anesthesia or ICU treatment) occurred in only 1.9% (n = 12) of cases with a perioperative mortality of 0.6% (n = 4). Infratentorial tumor location (OR 5.46, 95% 2.31-13.8, p = .001), reoperation (OR 2.31, 95% 1.07-4.81, p = .033) and central region tumor location (OR 3.03, 95% 1.03-8.60) showed to be significant predictors in a multivariate analysis for major AEs (CDG ≥ 2 or new neurological deficits). Neither deep supratentorial nor central region tumors were associated with more major AEs compared to convexity lesions.Modern microneurosurgical resection can be considered an excellent option in the management of BM in terms of safety, as the overall rate of major AEs are very rare even in eloquent and deep-seated lesions.© 2023. The Author(s).