Modern Surgical Approaches for Brain Metastases

Surgical resection is an important treatment consideration for patients with brain metastases, as it offers rapid symptom relief and enhances local control. Although surgery remains a mainstay of treatment, there exists increasing nuance in the selection of appropriate patients for surgical intervention and the choice of surgical adjuncts. This chapter reviews the current indications for open resection, evaluates surgical technique, and highlights the role of more minimally invasive strategies and other intraoperative adjuncts. In addition, it summarizes current evidence for the use of laser interstitial thermal therapy (LITT), brachytherapy, and Ommaya reservoirs, all within the context of evolving radiotherapy/radiosurgery and medical oncology paradigms.