Current surgical management of brain metastases

Abstract

Metastatic brain tumours are among the most common surgical targets in brain surgery. Up to 40% of cancer patients develop brain metastases during the course of their disease. Lung, breast, kidney, intestine and melanoma are the most common cancers, spreading into the CNS. New techniques in neurosurgery have lead to a significant increase in survival and quality of life of patients suffering from brain metastasis. Image guidance, intraoperative ultrasound, electrophysiological cortical mapping, functional neuronavigation and awake craniotomy expanded the indication of surgery even to patients suffering from multiple metastases. Thus, appropriate selection criteria are necessary to provide benefits of surgery to the widest population of patients possible. Besides traditional criteria like age, Karnofsky performance status (KPS), number, extension, surgical accessibility, histology and status of the systemic disease, recursive partitioning analysis has led to a new preoperative classification system (RPA Classes 1–3), to select patients, having best benefit from surgical treatment.