Surgical Management of Intracerebral Metastases

Metastatic brain tumors are the most common neurological complication in patients with systemic cancer. They are mainly cerebrally located and cause significant morbidity and mortality in such patients. Brain metastases have an incidence exceeding that of all other intracranial tumors, and their number is rising as improved systemic cancer treatments have extended patients’ lives. We have reviewed the role of surgery in management of intracranial metastases by considering patient selection criteria, neuroimaging, image-guided technology, neurosurgical technique, intraoperative adjuncts, whole brain irradiation as a postoperative adjuvant, resection of multiple vs. single metastases, and the relative roles of stereotactic radiosurgery and conventional surgery. It is important to realize that the presence of multiple brain metastases does not automatically contraindicate surgery because in properly selected patients, resection of multiple metastases can extend survival and enhance the quality of life. Proper management of metastatic brain tumors frequently requires the judicious use of open craniotomy, whole brain radiotherapy, and stereotactic radiosurgery. One needs to be aware of how these modalities can best complement each other and to apply them accordingly in order to assure the best outcome of patients with intracranial metastases.