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Brain Metastases Surgical Management: Diagnostic, Therapeutic and Strategic Considerations

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Abstract

The incidence of brain metastases (BM) is to date increasing, mostly due to the actual improvement of cancer patients’ overall survival with the advent of targeted therapies. BM management has dramatically evolved over the last 15 years and uses varying strategies including more or less aggressive local treatments, sometimes combined with systemic therapies that have led to an improvement of patient survival and quality of life. Surgical BM resection has been shown to be an effective treatment that improves overall survival compared to brain radiotherapy alone in patients with solitary brain metastases.

Brain metastases resection in patients with oligometastatic disease especially for large symptomatic lesions with mass effect represent the standard of care. However, surgical resection alone is insufficient to provide a durable local control, and recurrence in the surgical bed is common.

Recent studies indicate that local control could be improved through modern surgical techniques such as neuronavigation, brain mapping, and fluorescence-guided surgery. Furthermore, there is a growing body of evidence that the molecular documentation of metastatic brain disease could help to better define the systemic treatment strategy in these patients. Here, we reviewed the evidence-based data available in the literature on the actual prognostic impact of surgery in patients with BM and provided an overview of new surgical techniques and additions that can improve surgical resection. Finally, we discussed the current role of the neurosurgeon in the strategy and management of overall treatment in these patients with BM.

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Author information

Authors and Affiliations

  1. Département de Neurochirurgie, Ramsay Santé, Hôpital Privé Clairval, Marseille, France

    Philippe Metellus

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  1. Philippe Metellus
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Editor information

Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Metellus, P. (2020). Brain Metastases Surgical Management: Diagnostic, Therapeutic and Strategic Considerations. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_14

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