Surgery for metastatic intracranial neoplasm

The course of 167 patients with a surgically treated metastatic brain neoplasm is reviewed. The most common primary site was lung (37%) followed by breast and skin. Three quarters of the patients had a previous history of malignancy, and one third had a tumor visible on chest roentgenogram. Operative mortality was below 10% after 1950, and was lowest when complete tumor removal was achieved. Corticosteroids had little effect on operative mortality. Median survival after surgery was 6 months, but seven patients survived 5 years or more. Survival was longer if the primary tumor had been adequately treated previously. Surgery is indicated to establish the diagnosis in a patient without a known primary tumor or in one without evidence of dissemination except for a solitary brain tumor. In the latter instance, longterm palliation sometimes rewards aggressive management.