183or WBRT may provide palliation of symptoms in
sync with the medical or neuro- oncological team
approach. Aggressive cytoreductive surgeries are
often contraindicated in the context of the broader
health of these patients, especially if they are neu-
rologically compromised and have short life
expectancy at the time of presentation [ 40 ].
Treatment options for patients with SBM
include conventional chemotherapeutics (i.e.,
cytotoxic or hormonal) targeted at the specific
type of tumor. Surgical resection is typically
reserved for solitary or rapidly enlarging tumors
that are causing a high degree of morbidity and
decreased quality of life, although total resection
of these lesions is often precluded by involve-
ment of critical neurovascular structures.
Radiation therapy, or SRS, is often the treatment
modality of choice in these patients.
SRS is now a frequently used, precise method
for addressing local tumor control and SBM- related
symptom management. Most reports of SRS used
for SBM are positive, often citing patient symptom
improvement until time of death [ 41 – 43 ].Fig. 13.4 Images of a patient with an asymptomatic
ovarian cancer metastatic lesion to the left cerebellopon-
tine angle. (a, d) Preoperative axial (a) and coronal (b)
T1-weighted, gadolinium-enhanced MRIs demonstrating
moderately sized lesion, with mild edema visible on axial
(c) FLAIR and (d) T2-weighted images. Radiosurgery
was performed to 1800 cGy to the 90% isodose line using
dynamic conformal arc linear accelerator therapy (g). (e,
f) Three-month posttreatment axial (e) and coronal (f)
MRIs demonstrate significant decrease in size of the
lesion. (h–i) Two-year follow-up axial (h) and coronal (i)
MRIs demonstrate continued tumor control13 Metastasis to the Posterior Fossa