• Niklas Thon, Philipp Karschnia, Louisa von von Baumgarten, Maximilian Niyazi, Joachim P Steinbach, and Jörg-Christian Tonn.
• Department of Neurosurgery, Ludwig Maximillian University of Munich, Munich; German Cancer Consortium, Partner Site Munich, Munich; Department of Radiation Oncology, University Hospital, LMU Munich, Munich; Dr. Senckenberg Institute of Neurooncology, Center of Neurology and Neurosurgery, Frankfurt am Main; German Cancer Consortium, Partner Site Frankfurt, Frankfurt; University Cancer Center (UCT) Frankfurt, Frankfurt am Main; Department of Neurology, Klinikum der Munich University Hospital, Munich.
• Dtsch Arztebl Int. 2023 Mar 10; 120 (10): 162169162-169.

BackgroundMetastases are the most common malignant tumors affecting the central nervous system and occur in 20-40 percent of patients with solid systemic tumors. The aim of this review is to discuss the role of neurosurgical procedures in a modern, multidisciplinary treatment approach.MethodsAn expert panel of neurosurgeons, neurologists, and radio-oncologists conducted a selective literature review on neu - rosurgical interventions for the diagnosis and treatment of cerebral metastases. Original articles, meta-analyses, and systematic reviews were included.ResultsThere is a lack of prospective randomized studies. Based on retrospective case series, international guidelines recommend the harvesting (if required, stereotactically guided) of tissue for histological and molecular diagnosis in cases of unknown or possibly competing underlying systemic malignant diseases, in cases of suspected tumor recurrence, and with regard to the evaluation of targeted therapies taking into account molecular heterogeneity of primary and secondary tumors. Surgical resection is particularly valuable for the treatment of up to three space-occupying cerebral metastases, especially to achieve clinical stabilization to allow further non-surgical treatment. For cystic metastasis, a combination of stereotactic puncture and radiotherapy may be useful. Meningeal carcinomatosis can be treated with intrathecal medication via an intraventricular catheter system. Ventriculo-peritoneal shunts represents an effective treatment option for patients with tumor-associated hydrocephalus.ConclusionNeurosurgical procedures are of central importance in the multimodal treatment of cerebral metastases. The indications for neurosurgical interventions will be refined in the light of more effective radiation techniques and systemic treatments with new targeted therapeutic approaches and immunotherapies on the horizon.

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