Surgery is recommended for brain metastases that are large, have significant perilesional edema, result in neurological deficits, and present with uncertain pathology. In addition, surgery provides tissue diagnosis, when needed. Smaller targeted craniotomies and an emphasis on minimizing postoperative deficits have led to faster operations and discharge a few days after a craniotomy. Given the limitations of radiation therapy and other targeted therapies, surgery plays a critical role for patients, the timing of which is discussed in this guideline.

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