Computed tomography (CT) rules out neurosurgical emergencies, provides superior visualization of bony details, particularly if metastases involve the calvarium, and is used for patients with MRI contraindications. The preoperative workup of lesions suggestive of brain metastases centers on neuroimaging. This review will cover recent innovations in neurosurgical techniques and intraoperative considerations for the treatment of brain metastases ( Table 1). 7, 8 Given the growing epidemiological and clinical burden of brain metastases, advancements in surgical management are imperative. 1, 6 Neurosurgery is an essential tool in the therapeutic arsenal against brain metastases and has been shown to improve survival and quality of life. 6 As cancer treatment, diagnosis, and surveillance improve, incidence rates will continue to rise. 4, 5 Incidence rates of BMs are difficult to assess since no national registries exist specifically for patients with brain metastases, and current estimates likely underestimate the true burden of disease. 1 Population-based studies estimate that 8.5–9.6% of cancer patients will develop a BM, 2, 3 while autopsy studies suggest that approximately 25% of people who die of cancer had developed metastatic disease to the brain. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.īrain metastases (BMs) are the most common type of intracranial tumor in adults, occurring about 10 times more frequently than primary malignant brain tumors. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative.
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