Reviewing neurosurgical management of brain metastases : Three case reports

Introduction: Brain metastasis is a major cause of morbidity and mortality in patients with systemic malignancies. Newer imaging and treatment modalities have improved clinical outcome in last few decades.Objective: It reviews recent advances in the field of epidemiology, neuroimaging, neurosurgery, radiation therapy and other interventions affecting the clinical outcome of a patient with brain metastasis.Materials and Methods: Case record files of 3 patients operated by the author were reviewed for analyzing clinical and radiological presentations and outcome following neurosurgical intervention. Pre and post-operative clinical evaluation, neuroimaging, neurosurgical resection and histopathological confirmation of the metastasis followed by chemoradiation therapy were done in all cases.Results: Headache, seizures and neurological deficit were common presentations of patients with brain metastases. MRI brain with Gadolinium enhancement and MR spectroscopy were the investigations of choice. All three patients underwent neurosurgery for tumor decompression and histopathological confirmation of metastasis. Neurosurgery followed by chemoradiation therapy was beneficial in all cases.Conclusion: The course of clinical management of a patient with brain metastasis is guided by the prognostic indicators. About five decades ago, steroids, cerebral decongestants and whole brain radiotherapy (WBRT) was the mainstay of the treatment of brain metastasis. Newer treatment options include brachytherapy, chemotherapy, stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), stereotactic biopsy and neurosurgical excision. Aims of the neurosurgical excision are reduction of the intracranial pressure, improvement in neurological status and histopathological confirmation of the diagnosis.