The evolving role of surgery in brain metastatic disease

Advancements in diagnostic imaging have improved the detection of brain metastases, which are now recognized as the most common intracranial malignancies. While surgical intervention may be indicated for various reasons – including histopathological confirmation, relief of mass effect, neurological improvement, and survival benefits – evidence suggests that gross total resection is particularly important for enhancing both progression-free and overall survival. However, the management of brain metastases remains largely subjective and controversial. This review aims to critically evaluate existing evidence regarding the role of surgical intervention in the treatment of brain metastases.