What factors determine if surgical resection is recommended for metastatic brain tumors?

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CharlesCobbsMD (Physician - Neurosurgery (Verified) ) - 08 / 24 / 2012

Surgical resection of metastatic brain tumors can be controversial. There is clear evidence based on prospective randomized controlled studies that in patients with one metastatic brain tumor, they do better with surgical resection followed by radiation versus radiation alone. Therefore, in cases where there is a single metastatic tumor that is easily accessible surgically, surgical resection may be the best choice-especially the tumor is causing pressure on the adjacent brain. However, if there is a single metastatic tumor that is not causing significant mass effect and is deep in the brain or is in an area of brain that is critical such as the motor area or the speech area, then this type of tumor may be better treated by focused stereotactic radiation therapy. Often there is no clear right or wrong answer in terms of whether or not surgery for a single metastatic lesion should be done. In cases where there are more than one or two metastatic lesions, the role of surgery is considered to be much less appropriate unless one of these metastatic tumors is causing a huge amount of mass effect and needs to be removed in order to decompress the brain.
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