New guidelines for the surgical treatment of brain metastatic tumors of the American Association of Neurosurgeons

The guidelines are as follows:question: Should patients with newly diagnosed brain metastatic tumorsundergo surgery, stereotactic radiosurgery (Stereotactic Radiosurgery, SRS), or Whole Brain Radiotherapy (Whole Brain Radiotherapy, WBRT)?recommended:patients with single-shot brain metastatic tumors with generally good condition and fewer cranial comorbidities, it is recommended that surgery and WBRT be used as a first-line treatment to extend overall survival, median survival and local lesions control(Grade I Recommended)recommended surgical combination SRS therapy to provide survival benefits for patients with brain metastatic tumors(Class III recommended)for extending overall survival and local lesions control, it is recommended to include multi-modal therapy including surgery, WBRT, SRS, or surgery- and WBRT as an alternative to WBRT-SRS(Level III recommendation)Question: Do patients with newly diagnosed brain metastatic tumorsneed to undergo WBRT, SRS, or other treatment modes after surgical removal?recommendation:in patients with single-shot brain metastasis, surgery plus WBRT is better than simple WBRT(Class I recommended)surgery and SRS are better than simple SRS(Class III recommended) there is no significant difference between sRS and surgery-WBRT in terms of overall survival (Class III recommended) question: Do patients with brain metastatic tumor shave with surgery to remove it after relapse? recommended: in patients who relapse after initial surgery or stereotactic radiotherapy, re-opening craniofacial surgery is associated with survival improvement However, before re-opening the craniotomy, the preoperative function status, age, other extracranial comorbidities, and the time interval between SRS and resurgery need to be taken into account (Class III recommended) Question A: Does surgical technique (complete or block edgy) have an effect on tumor recurrence? recommended: to remove single brain metastatic tumor, compared to block removal, the complete removal of tumor can reduce the risk of developing soft meninges lesions after surgery (Class III recommended) Question B: the scope of surgical excision (full or partial excision) has an effect on recurrence? recommended: in the category I patients of classification decision analysis (Recursive partitioning analysis), complete excision is better than subtotal excision, which can improve the overall survival time and delay recurrence (Class III recommendation) generally, as described above, the benefits of surgery compared to pure radiotherapy were described above, which were most relevant in patients with KPS, younger age, good classification decision analysis, lower Eastern Cooperative Group Score, primary tumor control, 4 cm diameter of brain metastatic tumor, and tumor full-cut Although multimodal surgery is no less than WBRT-SRS, further research is needed to clarify the rational use of surgery in terms of the number of brain metastatic tumors, the site of the tumor, and the optimal timing between surgery and assisted radiotherapy The significance of surgery for recurrent brain metastasis deserves further study to clarify the difference between surgery and SRS as the initial treatment Particular attention should be paid to controlling the location, size and number of brain metastatic tumors The analysis of surgical techniques shows that the whole excision and tumor total cut is a better surgical method, and the part removal is related to the increased risk of soft meningiomed disease However, in addition to studying the role of assisted radiotherapy in tumor whole and block removal, future studies need to consider how to control tumor volume and spread.