Surgery for Brain Metastases

  • Sunit Das
  • Kenji Muro
  • Jeffrey J. Raizer
Part of the Cancer Treatment and Research book series (CTAR, volume 136)


It is estimated that 170,000 new cases of metastatic brain tumor are diagnosed in the United States each year [1]. As our population ages and oncologists are better able to achieve control of systemic disease, it is likely that the incidence of intracranial metastatatic disease will continue to increase. Brain metastases are thought to account for 20% of all cancer-related deaths each year [2]. Some tumor types are much more likely to result in metastatic spread to the brain; common primary sources include lung cancer, breast cancer, melanoma, and renal cell cancer, which together account for nearly three-fourths of all brain metastases [3].


Brain Metastasis Recursive Partitioning Analysis Metastatic Brain Tumor Karnofsky Performance Scale Recursive Partitioning Analysis Class 
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  1. 1.
    Larson D, Rubinstein J, McDermott M. Treatment of metastatic cancer. In: DeVita CT Jr, Hellman S, Rosenberg SA, editors. Cancer Principles and Practice of Oncology. Philadelphia: Lipincott Williams & Wilkins, 2004: 2323–2398.Google Scholar
  2. 2.
    Posner JP. Management of brain metastases. Rev Neurol (Paris) 1992; 148: 477–487.Google Scholar
  3. 3.
    Nusbaum ES, Djalilian HR, Cho KH, et al. Brain metastases: histology, multiplicity, surgery, and survival. Cancer 1996; 78: 1781–1788.CrossRefGoogle Scholar
  4. 4.
    Salvati M, Cervoni L, Raco A. Single brain metastases from unknown primary malignancies in CT-era. J Neurooncol 1995; 23:75–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Patchell RA, Tibbs PA, Walsh JW et al. A randomized trial of surgery in the treatment of single brain metastases to the brain: A randomized trial. N Eng J Med 1990; 322:494–500.CrossRefGoogle Scholar
  6. 6.
    Peacock KH, Lesser GJ. Current therapeutic approaches in patients with brain metastases. Curr Treat Options Oncol 2006; 7:479–489.CrossRefPubMedGoogle Scholar
  7. 7.
    Bindal RK, Sawaya R, Leavens ME et al. Surgical treatment of multiple brain metastases. J Neurosurg 1993; 79:210–216.CrossRefPubMedGoogle Scholar
  8. 8.
    Brega K, Robinson WA, Winston K et al. Surgical treatment of brain metastases in malignant melanoma. Cancer 1990; 66:2105–2110.CrossRefPubMedGoogle Scholar
  9. 9.
    Sundaresan N, Galicich JH. Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 1985; 55:1382–1388.CrossRefPubMedGoogle Scholar
  10. 10.
    Constantini S, Kornowski R, Pomeranz S et al. Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors. Acta Neurochir (Wien). 1991; 109:93–97.CrossRefGoogle Scholar
  11. 11.
    Sawaya R, Donlon JA. Chronic disseminated intravascular coagulation and metastatic brain tumor: a case report and review of the literature. Neurosurg 1983;12:580–584.CrossRefGoogle Scholar
  12. 12.
    Gaspar L, Scott C, Rotman M et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. In J Radiat Oncol Biol Phys 1997; 37:745–751.CrossRefGoogle Scholar
  13. 13.
    Morris SL, Low SH, A’Hern RP, et al. A prognostic index that predicts outcome following palliative whole brain radiotherapy for patient with metastatic melanoma. Br J Cancer 2004; 91: 829–33.PubMedGoogle Scholar
  14. 14.
    Vecht CJ, Haaxma-Reiche H, Noordijk EM et al. Treatment of single brain metastases: radiotherapy alone or combined with neurosurgery? Ann Neurol 1993; 33:583–590.CrossRefPubMedGoogle Scholar
  15. 15.
    Mintz AH, Kestle J, Rathbone MP, et al. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 1996; 78:1470–1476.CrossRefPubMedGoogle Scholar
  16. 16.
    Wronski M, Arbit E. Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer. 1999; 85:1677–1685.CrossRefPubMedGoogle Scholar
  17. 17.
    Iwadate Y, Namba H, Yamaura A. Significance of surgical resection for the treatment of multiple brain metastases. Antincancer Res 2000; 20: 573–7.Google Scholar
  18. 18.
    Pollock BE, Brown PD, Foote RL, et al. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol 2003; 61: 73–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Schackert G, Steinmetz A, Meier U, et al. Surgical management of single and multiple brain metastases: results of a retrospective study. Onkologie 2001; 24Ù 246–55.CrossRefPubMedGoogle Scholar
  20. 20.
    Weber F, Riedel A, Koning W, et al. The role of adjuvant radiation and multiple resection within the surgical management of brain metastases. Neurosurg Rev 1996; 19: 23–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Nieder C, Andratschke N, Grosu AL et al. Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases. Strahlenther Onkol 2003; 179:16–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Arbit E, Wronski M, Burt M, Galicich JH. The treatment of patient s with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 1995; 76: 765–73.CrossRefPubMedGoogle Scholar
  23. 23.
    Barker FG. Efficacy of prophylactic antibiotics for craniotomy: A meta-analysis. Neurosurgery 1994; 35: 484–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Galicich JH and French LA. Use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig Treat 1961; 12: 169–74.PubMedGoogle Scholar
  25. 25.
    Shaw MD and Foy PM. Epilepsy after craniotomy and the place of prophylactic anticonvulsant drugs: discussion paper. J R Soc Med 1991; 84: 221–223.PubMedGoogle Scholar
  26. 26.
    Kondziolka D and Lunsford LD. Intraoperative navigation during resection of brain metastases. Neurosurg Clin N Am 1996; 7: 267–77.PubMedGoogle Scholar
  27. 27.
    Tan TC and Black PM. Image-guided craniotomy for cerebral metastases: techniques and outcomes. Neurosurgery 2003; 53: 82–89.CrossRefPubMedGoogle Scholar
  28. 28.
    Cohen N, Strauss G, Lew R et al. Should prophylactic anticonvulsants be administered to patients with newly diagnosed cerebral metastases? A retrospective study. J Clin Oncol 1988; 6: 1621–24.PubMedGoogle Scholar
  29. 29.
    Regelsberger J, Lohmann F, Helmke K, et al. Ultrasound-guided surgery of deep seated brain lesions. European Journal of Ultrasound 2000; 12: 115–21.CrossRefPubMedGoogle Scholar
  30. 30.
    Keles GE, Lundin DA, Lamborn, KR, et al. Intraoperative subcortical stimulation mapping for hemispheric perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 2004; 100: 369–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neurology 2000; 54: 1886–93.PubMedGoogle Scholar
  32. 32.
    Hamilton MG, Hull RD, and Pineo GF. Venous thromboembolism in neurosurgery and neurology patients: A review. Neurosurgery 1994; 34: 280–96.CrossRefPubMedGoogle Scholar
  33. 33.
    Agnelli G, Piovella F, Buoncristiani P, et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1993; 339: 80–85.CrossRefGoogle Scholar
  34. 34.
    Black PM, Baker MF, and Snook CP. Experience with external pneumatic calf compression in neurology and neurosurgery. Neurosurgery 1986; 18: 440–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Frim DM, Barker FG, Poletti CE, et al. Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery 1992; 30: 830–33.CrossRefPubMedGoogle Scholar
  36. 36.
    Danish SF, Burnett MG, Ong JG, et al. Prophylaxis for deep venous thrombosis in craniotomy patients: A decision analysis. Neurosurgery 2005; 56: 1286–1294.CrossRefPubMedGoogle Scholar
  37. 37.
    Westphal M, Hilt DC, Bortey E, et al. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro-Oncology 2003; 5: 79–88.CrossRefPubMedGoogle Scholar
  38. 38.
    Brem S, Staller A, and Wotoczek-Obadia Mea. Interstitial chemotherapy for local control of CNS metastases. Presented at the annual meeting of the Society of Neuro-Oncology, Toronto, ON, Canada, November 18–21, 2004 (abstr TA-06).Google Scholar
  39. 39.
    Rogers LR, Rock JP, Sills AK, et al. Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg 2006; 105: 375–84.CrossRefPubMedGoogle Scholar
  40. 40.
    Bobo RH, Laske DW, Akbasak A, et al. Convection-enhanced delivery of macromolecules in the brain. Proc. Natl. Acad. Sci. 1994; 91: 2076–80.CrossRefPubMedGoogle Scholar
  41. 41.
    Muro K, Das S, Raizer, J. Convection-enhanced delivery of targeted cytotoxins to the central nervous system. Technology in Cancer Research and Treatment 2006; 5: 201–13.Google Scholar
  42. 42.
    Grossi PM, Ochiai H, Archer GE, et al. Efficacy of intracerebral microinfusion of trastuzumab in an athymic rat model of intracerebral metastatic breast cancer. Clin Cancer Res 2003; 9: 5514–20.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sunit Das
    • 1
  • Kenji Muro
    • 1
  • Jeffrey J. Raizer
    • 2
  1. 1.Department of Neurological SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoUSA

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