Agree with Dr Chao's answer above on this. In our institution, our treatment of these lesions (in the context of limited mets and no LMD) falls into 3 categories: -preop SRS, usually 15Gy/1fx to the lesion followed by resection that day, sometimes followed by post-op SRS if lesion still felt to be ...

In the setting of relatively limited number of brain metastases, there are 2 approaches. 1) Surgical resection with neoadjuvant or adjuvant SRS 2) SRS alone If surgical resection is done, I favor doing the SRS neoadjuvantly to minimize the risk of leptomeningeal spread which seems to be higher in...

I agree with @Samuel T. Chao and @Evan Thomas. Along with @Evan Thomas, I prefer fractionated SRS for this situation. I did have one patient require a shunt after SRS-induced edema of a lesion abutting the 4th ventricle. While this would be considered a high grade toxicity, it was fortunately r...