Surgical advances in the management of brain metastases

Abstract

As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. 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. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. 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. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.

Diagnostic and Therapeutic Particularities of Symptomatic Melanoma Brain Metastases from Case Report to Literature Review

“…Craniotomy has a mortality rate of between 1 and 3%, and can be associated with significant risks, including neurocognitive decline, leptomeningeal spread, and complications (wound infection, encephalitis, hematoma, hydrocephalus, edema, or seizures) that may require the postponement of the administration of oncologic treatment [15,40,41,48]. Nowadays, technical advances in neurosurgery, such as keyhole craniotomies and tubular retractors positioned with neuronavigational systems, limit these risks and enable surgery to be performed for multiple MBMs in areas previously accessible only through SRS [49].…”

Revisiting the Role of Surgical Resection for Brain Metastasis

“…The development of new chemotherapeutic drugs, evolving radiation therapy and SRS techniques, and treatment options for BM are varied. However, surgery remains a unique and essential tool for the treatment of BM [ 9 10 ]. In the SRS era, the role of surgery in the treatment of BMs needs to be refined, and efforts to overcome the drawbacks of surgery are necessary.…”

Outcomes and Molecular Features of Brain Metastasis in Gastroesophageal Adenocarcinoma

“…Surgical techniques, too, have evolved in recent years to allow for more precise preoperative planning and the preservation of normal brain parenchyma. 21 Given the limited data available regarding risk factors for and treatment of BrM from GEA, we sought to characterize the clinical and genomic features of patients with BrM from GEA. In addition, we evaluated associations of surgical resection and radiotherapy use with survival.…”

“…Studies comparing the efficacy of SRS vs WBRT have found noninferiority in regard to overall survival, although the risk of subsequently developing new BrM was increased with SRS treatment alone. Surgical techniques, too, have evolved in recent years to allow for more precise preoperative planning and the preservation of normal brain parenchyma . Given the limited data available regarding risk factors for and treatment of BrM from GEA, we sought to characterize the clinical and genomic features of patients with BrM from GEA.…”