Indications and Techniques for Surgical Intervention in Patients with Metastatic Brain Tumors

Abstract

Brain metastases occur in up to 30% of cancer patients and may be the presenting problem in as many as 20%. Advances in our understanding of cancer biology and precision therapeutics have resulted in improved systemic disease control for many cancers, making the treatment of metastatic disease to the central nervous system (CNS) more critical than ever. Surgery and adjuvant radiation have long been the mainstay of treatment. Surgery can provide a diagnosis, symptom relief, and ideally locally curative benefits. Surgical innovations and techniques such as single or multiple craniotomies for microsurgical excision, intraoperative brain mapping, minimally invasive parafascicular surgery (MIPS), intraoperative image-guided surgical resection, and laser interstitial thermal therapy (LITT) allow for the optimization of tumor removal and patient safety as never before. In this chapter, the reader will become familiar with the rationale for the surgical management of the patient with a brain metastasis and many of the techniques driving better surgical outcomes for our patients.