Our Summary

Brain metastases (BMs) are cancer cells that have spread to the brain from other parts of the body. They affect between 10-30% of cancer patients. As we get better at controlling primary cancer (the original site of the cancer), more patients are living long enough to develop BMs.

In treating BMs, surgeons often remove the lesions or tumors. To do this, they’ve been using less invasive methods, thanks to innovations in surgery. One method is minimally invasive cranial surgery (MICS), which involves small openings in the skull (less than 5 cm) and instruments that can gently push aside brain tissue (tubular retractors). The goal is to remove as much of the tumor as possible while injuring as little healthy brain tissue as possible.

Another method, called supramarginal resection, aims to remove even the microscopic bits of the tumor that might be left behind. This can help reduce the chances of the tumor coming back.

Because MICS uses small openings and has a limited ability to change its path during surgery, careful planning is needed before the procedure. Surgeons use different imaging techniques (like CT and MRI scans) to get a detailed look at the tumor and its relationship to important brain structures.

During surgery, tools like neuronavigation (like a GPS for the brain) help guide the surgeon and compensate for any shifts in the brain’s position. Other tools, like ultrasound, endoscopes, and exoscopes, can help surgeons see the boundaries of the tumor better.

All these less invasive tools and techniques are making brain surgery safer and more effective for patients with BMs.

FAQs

  1. What is minimally invasive cranial surgery (MICS) and how does it help in treating brain metastases (BMs)?
  2. What is supramarginal resection and how does it assist in reducing the chances of the tumor coming back?
  3. What tools and techniques are used in the planning and execution of minimally invasive surgery for brain metastases?

Doctor’s Tip

A helpful tip a doctor might tell a patient about minimally invasive surgery for brain metastases is to trust in the expertise of the surgical team and the advanced technology being used. It’s important to follow pre-operative instructions carefully, such as fasting before surgery and avoiding certain medications. After surgery, follow post-operative care instructions closely to ensure a smooth recovery. And most importantly, communicate openly with your healthcare team about any concerns or questions you may have throughout the process.

Suitable For

Patients who are typically recommended minimally invasive surgery for brain metastases include those who have smaller tumors, tumors located in easily accessible areas of the brain, and those who are at a higher risk for complications with traditional open surgery. Additionally, patients who are older or have other medical conditions that may make traditional surgery more risky may also be good candidates for minimally invasive surgery. It is important for patients to discuss their individual case with their healthcare team to determine the best treatment approach for their specific situation.

Timeline

Before minimally invasive surgery:

  • Patient is diagnosed with brain metastases through imaging tests like CT and MRI scans.
  • Patient and medical team discuss treatment options, including surgery.
  • Preoperative tests and evaluations are conducted to assess the patient’s overall health and determine the best approach for surgery.
  • Surgeons use imaging techniques to plan the surgery and identify the boundaries of the tumor.

After minimally invasive surgery:

  • Patient undergoes minimally invasive cranial surgery to remove the brain metastases.
  • Surgeons use tools like neuronavigation, ultrasound, endoscopes, and exoscopes during the procedure to ensure precise and effective tumor removal.
  • Postoperative care is provided to monitor the patient’s recovery and manage any potential complications.
  • Follow-up appointments are scheduled to assess the patient’s progress and determine the effectiveness of the surgery in treating brain metastases.

What to Ask Your Doctor

Questions a patient should ask their doctor about minimally invasive surgery for brain metastases may include:

  1. What are the benefits of minimally invasive cranial surgery (MICS) compared to traditional open surgery for removing brain metastases?
  2. How is MICS performed and what are the potential risks or complications associated with this procedure?
  3. What imaging techniques are used to plan for and guide the surgery, and how do they help ensure the best possible outcome?
  4. How does neuronavigation technology assist the surgeon during the procedure, and how accurate is it in guiding the surgical tools?
  5. What tools or techniques are used to ensure that all of the tumor is removed during surgery, including any microscopic bits that may be left behind?
  6. How long is the recovery time for minimally invasive surgery compared to traditional open surgery for brain metastases?
  7. Are there any specific criteria or considerations that make a patient a good candidate for minimally invasive surgery?
  8. What is the success rate of MICS for removing brain metastases, and what are the chances of the tumor coming back after surgery?
  9. How experienced is the surgical team in performing minimally invasive cranial surgery for brain metastases, and what is their success rate with this procedure?
  10. Are there any alternative treatment options for brain metastases that should be considered in addition to or instead of minimally invasive surgery?

Reference

Authors: Perez NA, Choi BD, Nahed BV. Journal: Adv Cancer Res. 2025;165:165-230. doi: 10.1016/bs.acr.2025.04.003. Epub 2025 May 8. PMID: 40518190