Paulo Roriz
Breast cancer is the most prevalent cancer in women globally, and metastasis is the leading factor in breast cancer patients’ deaths. 10% to 16% of patients with metastatic breast cancer experience central nervous system metastasis, this rate has increased as a result of new developments in systemic treatment. Accurate diagnosis and evaluation for treatment are crucial because there are several treatments for brain metastases. One of the most trustworthy preoperative tests is Magnetic Resonance Imaging (MRI), which can also be used to estimate the molecular characteristics of a tumor based on radiographic data such as the number of lesions, solid or ring enhancement, and cyst formation. In patients with a small number of brain metastases and a generally satisfactory performance status, surgical excision remains to be crucial. For a prolonged survival time, single brain metastasis is a solid justification for surgical treatment followed by radiation therapy. If neurological symptoms are brought on by brain lesions larger than 3 cm in diameter with a mass effect or concomitant hydrocephalus, surgical excision of two or more lesions is also a possibility. Supramarginal resection can be accomplished in a few rare instances, despite the fact that maximal safe resection with little morbidity is desired in the surgical treatment of brain tumors. En-bloc resection is typically advised in relation to the resection strategy to prevent leptomeningeal dispersion brought on by piecemeal resection. Modern neurosurgery treatments, including tumor removal, require the use of an operating microscope, neuronavigation, and intraoperative neurophysiological monitoring. Supporting surgical instruments have just recently been developed. Endoscopic surgery has become increasingly popular, particularly for transsphenoidal procedures and intraventricular lesions. Regardless of the placement or anatomy of the patient, a neurosurgeon can operate comfortably with the use of an exoscope. A tubular retractor, which is a helpful tool when used with both an endoscope and an exoscope, helps guard against harm to the surrounding brain tissue during surgery. A promising drug for the photodynamic identification of remaining tumor tissue is 5-Aminolevulinic Acid (5-ALA). Novel treatment alternatives will soon be made available, including High-Intensity Focused Ultrasound (HIFU), Laser Interstitial Thermal Therapy (LITT), oncolytic virus therapy, and gene therapy.