Intracranial metastases

The incidence of brain metastases is increasing due to better management of the systemic primary disease, a lack of chemotherapeutic agents that cross the blood–brain barrier, and more sensitive imaging methods. Presenting symptoms include seizures, headache, and neurological deficit caused by the tumour and associated oedema. Steroids and antiepileptic drugs assist in initial symptom control, and allows assessment of the patient’s performance which remains an important determinant of treatment and outcome. Assessment starts with history and examination, contrast-enhanced MRI brain, and whole-body staging. Newer multimodal MRI techniques can help in diagnostic and treatment dilemmas. Definitive treatments include surgery, radiosurgery, whole-brain radiotherapy, and chemotherapy. The optimal combination and timing of these therapies remains controversial, however there are principles of management that can help the physician guide the patient on the best course. A true multidisciplinary approach is required to optimize treatment and care in an efficient and effective manner.