To the Editor: We read with great interest the letter by Voglis et al1 commenting on our recent study, “Impact of Extent of Resection on Survival in Brain Metastasis: An Analysis of 867 Patients.”2 We thank the authors for their thoughtful appraisal of our study. We furthermore congratulate them with their timely meta-analysis on extent of resection in brain metastases,3 the findings of which are convergent with our own results. Their systematic review provides an important synthesis of the growing body of evidence supporting the relevance of extent of resection and residual tumor volume in brain metastasis surgery. We agree that volumetric parameters will likely play an increasingly large part in surgical approaches to brain metastases, particularly as imaging and segmentation tools continue to evolve. The authors also raise the interesting concept of reducing total intracranial tumor burden through resection of multiple metastases, even when this might entail multiple craniotomies. This approach is intriguing and its application may benefit selected patients. At the same time, its advantages must be carefully balanced against the cumulative surgical risk and the availability of increasingly effective alternatives to surgical resection for some tumor types. We believe this represents one of the several open avenues of investigation in the ongoing refinement of neurosurgical management for patients with brain metastases. We commend Voglis et al for their comprehensive addition to the literature and look forward to future collaborative efforts aimed at improving neurosurgical care for brain metastasis patients.
Hulsbergen et al. (Fri,) studied this question.