Neurosurgical management of patients with brain metastasis

Brain metastasis is a serious complication in patients with systemic cancer. The main goal of the treatment in patients with brain metastasis is to control the disease in the brain, to prevent death from neurological disease and provide a satisfactory quality of life. Management of a patient with brain metastasis is important and sometimes demanding, and several factors such as tumor histology, status of primary disease, number of brain lesions, size of lesions, and performance status may influence the decision making process. We reviewed the neurosurgical treatment modalities in patients with metastatic brain tumor and suggested a treatment paradigm for different clinical conditions. The PubMed database was searched using combinations of search terms and synonyms for “management of brain metastasis,” “stereotactic radiosurgery for brain metastasis,” and “surgery for brain metastasis” between January 1, 1990, and January 1, 2018. This review would guide physicians to solve challenging problems in the treatment of patients with brain metastasis. In summary, local aggressive treatments such as surgical resection and stereotactic radiosurgery are reasonable in patients with limited intracranial disease, controlled primary disease, and high performance status. Besides, WBRT is still the standard treatment in patients with low performance score and leptomeningeal dissemination of cancer.