Surgery for Brain Metastases

Brain metastases occur when cancer cells from another part of the body spread to the brain. They are a common complication of lung, breast, melanoma, and colorectal cancers.

This blog aims to provide information about surgery for brain metastases, helping you to be informed in your treatment decisions.

Treatment for brain metastases is based on factors such as the number of metastases, their size, the type of cancer, and your overall health and preferences. Treatments may also be combined. The following are some treatment options for brain metastases:

• Surgery: Surgery may be an option if there are one or a few tumors and they can be safely reached.
• Radiation Therapy:
  • Whole Brain Radiation Therapy (WBRT): This approach delivers radiation to the entire brain and can be used for multiple metastases.
  • Stereotactic Radiosurgery (SRS): This technique precisely delivers a higher dose of radiation to a specific target, usually small, well-defined metastases.
• Chemotherapy: Some chemotherapy drugs can treat cancer in the body and treat brain tumors.
• Immunotherapy: Immunotherapy drugs help the immune system to recognize and attack cancer cells.
• Targeted Therapy: These drugs can interrupt pathways that lead to cancer growth.
• Supportive Care: These treatments help to improve your quality of life. They may include medications for pain management, anti-seizure drugs, and supportive therapies.

Your care team may include oncologists, neurosurgeons, radiation oncologists, and other healthcare professionals. They will work together to understand your specific situation and create a treatment plan tailored specifically to you.

The decision to undergo surgery involves careful consideration of your specific situation, including your neurological status and expected quality of life after surgery. Your doctor will help guide you through this decision-making process. 

Surgery for brain metastases is typically considered with the following criteria: 

• Single or Few Metastases: There are one or a few brain metastases that can be easily distinguished from your healthy brain tissue.
• Systemic Disease Control: The cancer is well-controlled and you have a favorable prognosis.
• Symptomatic Lesions: The metastases are causing symptoms such as seizures or changes in brain function.
• Surgically Accessible Lesions: Tumors are located in areas of the brain that can be safely accessed by your surgeon.

Surgical resection of brain metastases is a multi-step process that will be explained thoroughly to you by your care team prior to proceeding. The surgical approach to each patient can vary widely; we highlight the most important portions of the time around surgery here: 

• Medical Assessment: Your doctors will conduct a medical assessment to ensure you are in good health and can tolerate surgery.
• Imaging Studies: Tests such as MRI or CT scans will help your surgeon to locate the metastases and plan the surgery.

Admission: You will be admitted to the hospital, where your care team will help you prepare for the procedure.

Anesthesia: The surgery is performed under general anesthesia, meaning you will be asleep and won’t feel pain during the procedure.

Tumor Removal: Your surgeon will carefully remove or reduce the size of the tumors, often using advanced techniques such as image-guided surgery to protect your healthy brain tissue.

• Recovery Room: You will wake up in the recovery room.
• Hospital Stay: The length of your hospital stay may vary, but you will typically spend a few days in the hospital for monitoring and recovery.
• Imaging studies: Your doctor may order another MRI test to assess the completeness of tumor removal.
• Pain Management: Pain medications are provided to manage any pain or discomfort.
• Monitoring: Your healthcare team will monitor your vital signs and neurological status during your recovery.
• Rehabilitation services: You may benefit from rehabilitation services to aid in your recovery after surgery.

Like any surgery, brain surgery has certain risks. These risks can vary based on individual circumstances.

Your healthcare team will discuss your personalized risk factors with you, as well as potential benefits. This is all done so that you can make an informed decision about your treatment. Potential risks include:

• Infection: Although rare, surgical procedures carry a risk of infection. In brain surgery, there is a risk of infections in the brain or surrounding tissues.
• Bleeding: Brain surgery involves working with delicate blood vessels. There is a risk of bleeding during or after the surgery, which could lead to complications.
• Brain swelling (Cerebral Edema): Brain surgery can sometimes cause swelling in the brain, which can increase pressure inside the skull.
• Neurological Deficits: When operating on metastases, there is a risk of damage to surrounding healthy brain tissue. This could lead to neurological issues, such as weakness, sensory changes, or problems with speech and coordination.
• Seizures: Surgery on the brain can increase the risk of seizures during or after the procedure.
• Cognitive Changes: Some patients may experience memory problems, difficulty concentrating, changes in personality, or other cognitive changes after surgery.
• Anesthesia Risks: General anesthesia comes with its own risks, including reactions to medications, breathing difficulties, or cardiovascular issues that may be fatal.
• Recurrence: Even with successful surgery, there is a chance that the cancer could return. This may require further treatment.

Survival rates after surgery will vary based on the type of cancer, how much it has spread, and how well the treatment is working. In many cases, surgical treatment of brain metastases can improve survival, especially when combined with other treatments.

Your care team will work with you to navigate life after treatment, offering support for long-term care and quality of life. This support may include regular imaging and visits with the oncology team to monitor for recurrence.

• Facing brain metastases is challenging, but with the right information and support, you can make informed decisions about your care.
• Surgery has an important role in treatment of brain metastases.
• Those with one or a few brain metastases and well-controlled primary cancer may be good candidates for surgery.
• It’s important to discuss the risks and benefits of surgery with your neurosurgeon to decide if surgery is the right option for you.

• American Association of Neurological Surgeons (AANS): Metastatic Brain Tumors
• National Cancer Institute (NCI): Brain Tumors
• National Brain Tumor Society: Signs & Symptoms
• CancerCare: Brain Cancer