MANAGEMENT OF METASTATIC BRAIN-TUMORS

Background: Brain metastases are the most common neurological complica tion of systemic cancer. They represent a serious cause of morbidity a nd mortality and a significant challenge for neurosurgeons. They outnu mber all other intracranial tumors combined and, with advances in tech nology and treatment of systemic cancer, are on the increase as cancer patients live longer. Methods: We have reviewed the major factors tha t influence the occurrences of metastases in the central nervous syste m: primary cancer, patient age and sex, clinical aspects of presentati on, basic diagnostic modalities, diagnostic imaging (computed tomograp hy and magnetic resonance imaging), and treatment considerations. In d iscussing these different aspects, we emphasize the efficacy of differ ent treatment options, including recent information regarding multiple metastases that broadens the scope of surgical implications. The crit eria we present are directed toward considerations made by general sur geons, as well as those made by neurosurgeons. Conclusions: Although r adiotherapy remains the main therapeutic modality, surgical excision h as increasingly shown advantages in certain settings, as has stereotac tic radiosurgery. Chemotherapy is less effective, but its advantages a re reviewed, as are the implications of recurrent metastases.