Metastatic Brain Tumors: Surgery – Treatment

00:01 How do we treat brain metastasis? Well, they're common.

00:04 There's been a lot of studies and understanding about how we should treat these patients.

00:08 Brain metastasis are the most common central nervous system malignancy, with about over 160,000 new cases per year.

00:15 And there are two treatments that I want you to think about.

00:19 The first is surgery or a craniotomy.

00:22 Going in and taking out a symptomatic lesion, making a diagnosis, and then sending the patient to subsequent treatment.

00:30 The second is radiation therapy.

00:32 And we'll learn about multiple different types of radiation, including stereotactic radiosurgery, which you can see here that really reduces the risk of subsequent brain metastasis.

00:42 And we'll talk more about this in the next few slides.

00:46 When do we think about surgery? Well, surgery is really optimal in three situations.

00:51 If there is a solitary, a single, one single lesion, we can go after it with surgery and help that patient.

00:58 Lesions that are superficial, tumors that are superficial, are easy to access.

01:02 And then importantly, those that are symptomatic as a result of mass effect that need decompression, or management of new patient symptoms.

01:11 There are times when we worry about surgery.

01:14 Surgery for metastasis in the posterior fossa is really important, but those tumors are at higher risk for seeding the leptomeningeal space.

01:23 Postoperative radiation therapy to the resection cavity even after surgery is common in patients.

01:29 So surgery may be the start of treatment, but often is not the end.

01:35 There are some reasons to do a craniotomy, a surgery, and some contraindications. Some reason to worry about that.

01:40 Indications or reasons to do surgery, or if the patient doesn't have a cancer diagnosis, and that's the tissue that we need to establish the patient's diagnosis.

01:49 For large or symptomatic tumors, and typically those are tumors that are larger than three centimeters are associated with midline shift or mass effect around the brain.

01:59 And then recurrent brain metastases that have previously been treated with radiosurgery or stereotactic radiation, or radiation therapy, and are higher risk for subsequent radiation treatment.

02:08 There are also some times where we wouldn't want to do surgery.

02:11 Eloquent area the are areas of the brain.

02:13 That just are not amenable to surgical resection.

02:17 When a patient's health is declining, or when surgery would delay, urgent need for a good chemotherapy.