When is brain tumour surgery recommended for brain metastases?

Brain metastases are secondary brain tumours that began elsewhere in the body. Surgery may be considered for one accessible lesion, or occasionally a small number of lesions, particularly when it is large, causing swelling, bleeding, seizures or pressure on nearby brain tissue. Removing tissue can relieve pressure and provide a sample for diagnosis or treatment planning. The team also considers the number and location of lesions, the primary cancer, cancer elsewhere in the body, general health and whether medicines, focused radiation or whole-brain treatment would be more suitable.

Ask for coordinated review by neurosurgery, medical oncology and radiation oncology. The team will use brain imaging and information about the original cancer to compare surgery with focused radiation, medicines or supportive treatment. Tell clinicians about seizures, weakness, speech or vision changes, blood-thinning medicines and previous cancer treatment. Ask about steroid treatment for swelling, seizure prevention, rehabilitation, wound care and how the brain plan connects with treatment of cancer elsewhere.

Call emergency services for a first seizure, a seizure that does not stop, sudden one-sided weakness, new trouble speaking, severe confusion, collapse or a sudden severe headache. After surgery, urgent review is needed for fever, worsening headache, repeated vomiting, new weakness, increasing drowsiness or a wound that is opening or draining. Prompt assessment can identify swelling, bleeding or infection.

How many lesions are present and where are they located? Is the accessible lesion causing swelling or pressure? Would surgery change the next cancer treatments? What are the alternatives, and what neurological recovery and rehabilitation should I expect?