Stereotactic Radiosurgery in the Management of Brain Metastasis

Michael L. Smith, M.D.; John Y. K. Lee, M.D.


Neurosurg Focus. 2007;22(3) 

In This Article


Stereotactic radiosurgery has emerged as a noninvasive and effective means of improving patient survival as well as local control in patients with brain metastases. Two evidence-based management strategies that can be justified on the basis of randomized clinical trials are resection followed by WBRT or WBRT followed by SRS. Stereotactic radiosurgery and resection are overlapping and complementary techniques. Single, large, and superficial lesions in noneloquent brain regions in patients with favorable prognostic factors should be resected. Multiple deep lesions in the medically frail patient should be treated with SRS. Between these two extremes lie the majority of patients, and thus the art of medical management requires an understanding of the strengths and weaknesses of the three tools in the armamentarium: WBRT, SRS, and resection.


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