The Management of Brain Metastases-Systematic Review of Neurosurgical Aspects

Simple Summary In this comprehensive review, we focused on the neurosurgical treatment as an integrative part of the challenging multidisciplinary management of cerebral metastases, a neuro-oncologic entity, which has been observed to have an increased incidence over the last years. In selected cases, the surgical removal of the space-occupying mass reduces the intracranial pressure, normalizes the metabolic environment, reduces the symptom burden, and allows for the intensification of local and systemic adjuvant treatment. In detail, we discuss the incidence of brain metastases, the role of surgical resection, as well as the evolution of current neurosurgical techniques, the surgical morbidity and mortality of single and multiple lesions, and we enlighten the role of surgery for recurrent tumors. The multidisciplinary management of patients with brain metastases (BM) consists of surgical resection, different radiation treatment modalities, cytotoxic chemotherapy, and targeted molecular treatment. This review presents the current state of neurosurgical technology applied to achieve maximal resection with minimal morbidity as a treatment paradigm in patients with BM. In addition, we discuss the contribution of neurosurgical resection on functional outcome, advanced systemic treatment strategies, and enhanced understanding of the tumor biology.

Automated summary

This comprehensive review focuses on the role of neurosurgical treatment in the challenging management of cerebral metastases, which have been increasing in incidence over recent years. It discusses the benefits of surgical resection in reducing intracranial pressure and symptom burden, as well as the advancements in neurosurgical techniques and the multidisciplinary approach to patient care. The review highlights the importance of maximal resection with minimal morbidity, functional outcomes, and understanding tumor biology in the treatment of brain metastases.