[Surgical management of cerebral metastases]

Surgical treatment of metastatic brain tumors had been controversial until two prospective randomized trials demonstrated that surgery followed by radiation is superior to radiation alone in patients with single metastasis. In this report, we reviewed current perspectives on the neurosurgical treatment of brain metastasis. The goals of surgery is to establish a histologic diagnosis, relieve symptoms and provide local cure through gross total resection. The results which established surgery as the preferred treatment for single brain metastasis were largely a result of advances in neurosurgical techniques of localization and neuroimaging, microdissection, and functional mapping. These modern methods have reduced the operative mortality to 3% and the morbidity to less than 10%. The indications of surgical treatment should be related to clinical and radiological criteria. Surgical treatment is best indicated for single and accessible metastasis and is also accepted for patients with multiple lesions especially when there is a life-threatening lesion or when two lesions are accessible through the same craniotomy or for recurrent brain metastasis. Surgery can also be a good option for recurrent metastasis. Altogether, surgery improves quality of life and the median survival time, all the more as pronostic factors are present such as age>60 years, long interval between diagnosis of the primary tumor and the metastasis, the absence of systemic disease and a Karnofsky score> 70.