Brain Metastases — Timoteo Almeida, MD, PhD

Brain Metastases

Cancers that have spread to the brain from elsewhere in the body. As systemic treatments improve, controlling intracranial disease while preserving neurologic function is more important — and more achievable — than ever.

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Multidisciplinary treatment

Care often involves neurosurgery, radiation oncology, and medical oncology working together to create the right plan.

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Focused radiosurgery (SRS)

Current guidance supports SRS in many patients to control lesions while limiting cognitive effects of broader-field radiation.

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Biopsy & laser ablation

Robotic biopsy can clarify diagnosis, and laser ablation (LITT) can treat selected deep, recurrent lesions or radiation necrosis.

Understanding your condition

What are brain metastases?

Brain metastases occur when cancer cells from another part of the body — such as the lung, breast, skin, kidney, or colon — spread to the brain. They can cause headaches, seizures, weakness, visual changes, or may be found on routine surveillance imaging before symptoms develop.

Because systemic cancer treatments have improved significantly, many patients are living longer — which makes controlling intracranial disease while preserving neurologic function and quality of life increasingly important.

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A team approach

Brain metastasis treatment is planned collaboratively by neurosurgery, radiation oncology, and medical oncology. Each case is reviewed to determine the best combination of surgery, radiosurgery, systemic therapy, and surveillance.

Am I a candidate?

Who may be a candidate for Gamma Knife or other focal therapies?

Candidacy depends on:

Every case is individualized based on a combination of tumor, patient, and systemic disease factors.

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Number, size, and location of metastases and total tumor volume.
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Symptoms and urgency — some situations favor surgical resection for rapid decompression before or instead of radiosurgery.
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Overall health status and systemic disease control — coordinated with your medical oncologist.

Your options

Treatment Options

Three focal approaches serve different roles in brain metastasis management — from primary treatment to diagnostic clarification to managing treatment-related complications.

☢ Radiosurgery

Gamma Knife Radiosurgery

Stereotactic radiosurgery (SRS) for brain metastases

How it works Delivers a highly focused radiation dose to each lesion with sub-millimeter precision, sparing surrounding brain tissue.

When used Intact metastases, post-surgical resection cavities, or recurrent lesions. Used for both single and multiple metastases in appropriate patients.

Key advantage ASTRO-supported approach that can control lesions while limiting cognitive effects compared with whole-brain radiation.

Outpatient No incision Same-day Multi-lesion

🤖 Diagnostic

Robotic Stereotactic Biopsy

Robot-assisted tissue diagnosis

How it works A small incision guides a biopsy needle to the lesion using robotic stereotactic assistance, with high reported diagnostic yield.

When used When imaging can't reliably distinguish tumor recurrence from treatment effect — or when pathology will change the systemic treatment plan.

Key advantage Diagnostic clarity guides better treatment decisions. Robotic assistance supports precision and is associated with high accuracy in systematic reviews.

Diagnostic Minimally invasive Short stay

🔥 Ablation

Laser Ablation (LITT)

MRI-guided laser interstitial thermal therapy

How it works A minimally invasive laser probe is placed under MRI guidance. Real-time MRI thermometry monitors the ablation to protect surrounding tissue.

When used Selected patients with recurrent metastasis after SRS, radiation necrosis, or deep/eloquent lesions where open surgery is less desirable.

Key advantage Minimally invasive control of select lesions. A biopsy can often be obtained during the same procedure, confirming diagnosis and guiding next steps.

Minimally invasive MRI-guided Biopsy + ablation

Gamma Knife Immobilization Options

Modern platforms offer two approaches — your team will recommend the best fit for your case.

Frame-based

Rigid Head Frame

Traditional stereotactic accuracy with same-day treatment delivery. The frame is placed under local anesthesia on the morning of treatment and removed the same day.

Mask-based (frameless)

Frameless with Onboard Imaging

Improved comfort for some patients, with onboard imaging and motion management. Enables fractionated treatment in appropriate scenarios — spreading the dose over multiple sessions.

Your journey

What to Expect

The process depends on which treatment is planned, but always begins with a multidisciplinary review.

Before

Multidisciplinary review involving neurosurgery, radiation oncology, and medical oncology. Brain MRI with contrast, steroid management, and anti-seizure planning as needed.

During

Gamma Knife: Outpatient treatment; frame or mask placement; imaging-based planning followed by treatment delivery.
Robotic biopsy: Small incision; short hospital stay; pathology results guide the next treatment step.
LITT: Minimally invasive probe placement with real-time MRI thermometry; frequently a short hospital stay.

After

Follow-up MRI schedules vary based on treatment and tumor type. Coordination with your medical oncologist is essential — most patients resume systemic therapy per oncology guidance after recovery.

Weighing your options

Benefits and Risks

Potential Benefits

✦ Local tumor control with focused, targeted therapy
✦ Reduced treatment burden compared to whole-brain approaches in some patients
✦ Diagnostic clarity through biopsy — guiding better systemic treatment decisions
✦ Minimally invasive control of select recurrent lesions or radiation necrosis (LITT)

Possible Risks

Radiosurgery

△ Temporary fatigue, headache, radiation-related swelling
△ Radiation necrosis in a subset of patients

Biopsy / LITT

△ Bleeding, infection, neurologic deficit, seizure, and anesthesia risks (rates vary by lesion and approach)

Common questions

Patient FAQs

Why not treat everything with whole-brain radiation?

Guidelines emphasize individualized decisions. Focal SRS is often used to control lesions while limiting broader brain exposure when appropriate — potentially reducing cognitive effects compared to whole-brain radiation. Your team will recommend the best approach for your specific situation.

Do I need a head frame?

Some cases use a frame for maximum precision; others can use a comfortable mask with onboard imaging, depending on the location, size, and fractionation plan. Your team will discuss which option is best for you.

What is LITT used for?

LITT is often used for selected recurrent lesions or radiation necrosis, especially when open surgery is less desirable. A biopsy can often be obtained during the same procedure, which helps confirm the diagnosis and guide next steps in your treatment plan.

When to Seek Urgent Care

Seek urgent evaluation for seizures, sudden weakness or numbness, severe headache with vomiting, confusion, or fever — especially while on steroids or after a procedure.