A Comprehensive Analysis of the Management of Brain Metastases—Experience from a South-Eastern European Neurosurgical Centre

Background: Brain metastases represent the most common intracranial tumours in cancer patients, with no consensus on surgical outcomes and prognostic factors. This study aimed to analyse the demographic, clinical, and tumour-related factors influencing postoperative complications, recurrence, and functional outcomes in patients undergoing surgical resection of brain metastases at a tertiary neurosurgical centre in South-Eastern Europe. Materials and Methods: A retrospective cohort of adult patients who underwent gross total (GTR) or subtotal resection (STR) for brain metastases was analysed, stratified by sex, extent of resection (GTR vs. STR), and recurrence status. Results: A total of 358 patients underwent surgical resection for brain metastases, with pulmonary carcinoma being the most common primary tumour (46.4%). Most patients had solitary metastases (87.4%), and eloquent brain regions were involved in 53.9% of cases, 20.1% experienced postoperative complications, and recurrence occurred in 10.9%. Higher preoperative KPS predicted fewer complications. GTR was not associated with complications or recurrence but was linked to lower postoperative mortality. Median overall survival was 325 days. For the three hundred fifty-four patients with survival data, median overall survival (OS) was 325 days (95% CI: 270–380). OS did not meaningfully differ by sex. Conclusions: Gross total resection was not independently associated with reduced postoperative complications or recurrence but was significantly associated with lower postoperative mortality. Functional status, eloquent brain region involvement, and age remained key determinants of clinical outcomes.