Unifying Concepts

Advantages of Surgery and Stereotactic Radiosurgery for Brain Metastases

Stereotactic radiosurgery is an appropriate form of therapy for patients who have one to four brain metastases, no larger than 4 cm in diameter, from metastatic cancer. It appears to be effective for all types of primary tumors, even those that have been considered to be resistant to conventional radiation therapy.

Characteristics of Brain Metastases That Make Them Ideal Targets of Radiosurgery.

  • Well-defined on imaging (MRI and CT)
  • Spherical or pseudospherical shape
  • Most <4 cm in maximum diameter
  • Generally noninfiltrative
  • Located at gray–white junction

* CT denotes computed tomography, and MRI magnetic resonance imaging.

Advantages of Surgery and Stereotactic Radiosurgery for Brain Metastases.

  • Treatment of larger lesions (>4 cm in diameter)
  • Rapid resolution of mass effect and edema
  • Removal of cancer
  • Histologic confirmation of cancer
  • Rapid tapering of the dose of corticosteroids used to treat symptomatic lesions
  • Less intensive follow-up
  • Lower risk of radiation necrosis when combined with whole-brain radiation therapy

Stereotactic Radiosurgery

  • Treatment of small, deep lesions or eloquent areas
  • Minimally invasive or noninvasive approach
  • General anesthesia not required
  • Outpatient procedure
  • Treatment of multiple lesions during the same session
  • Short recovery time (<1 wk)
  • Potential avoidance of whole-brain radiation therapy
  • Rapid initiation of systemic therapies



  1. Suh JH. Stereotactic radiosurgery for the management of brain metastases. N Engl J Med. 2010 Mar 25;362(12):1119-27. [Medline]
  2. Halasz LM, Rockhill JK. Stereotactic radiosurgery and stereotactic radiotherapy for brain metastases. Surg Neurol Int. 2013 May 2;4(Suppl 4):S185-91. [Medline]


Created Mar 06, 2013.


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