Brain Metastasis Surgery & Treatment in New York City

Advanced Surgical Management • Multidisciplinary Oncology • Connectomics-Guided Precision

Overview

Brain metastases occur when cancer spreads to the brain from another part of the body. Treatment may include surgery, stereotactic radiosurgery, systemic therapy, or a combination of approaches depending on the number, size, location, symptoms, tumor biology, and prior treatment of the metastases.

Randy S. D’Amico, MD, is a neurosurgical oncologist at Lenox Hill Hospital in New York City and Director of Northwell Health’s Brain & Spine Metastasis Program. He specializes in surgery for brain metastases, including large or symptomatic tumors, recurrent metastases, tumors previously treated with radiation, and complex lesions involving critical brain networks.

The Brain & Spine Metastasis Program provides multidisciplinary evaluation with neurosurgery, radiation oncology, medical oncology, and other specialists. Rapid evaluation is available for patients with newly diagnosed or symptomatic brain metastases and for patients seeking a second opinion.

When Is Surgery Recommended for Brain Metastases?

Surgery may be considered when:

  • A metastasis is large or causing significant mass effect

  • Swelling is producing neurological symptoms or increased intracranial pressure

  • Tissue is needed to establish or clarify the diagnosis

  • One or more surgically accessible tumors are contributing to symptoms

  • Rapid relief of mass effect is needed

  • A lesion progresses despite radiation or systemic therapy

  • A previously irradiated lesion enlarges and radiation necrosis cannot be reliably distinguished from recurrent tumor

  • Surgery may facilitate subsequent radiation or systemic treatment

Dr. D’Amico frequently evaluates patients for second opinions to determine whether surgery, radiation, systemic therapy, or a combination is most appropriate.

Brain Metastasis Surgery vs. Radiation

Many brain metastases can be treated effectively with stereotactic radiosurgery (SRS) without an operation. Surgery is more often considered when a tumor is large, causing significant symptoms or mass effect, tissue is needed for diagnosis, or there is uncertainty about recurrent tumor versus radiation necrosis.

For some patients, the best approach combines surgery with focused radiation to the surgical cavity or treatment of additional metastases. The decision should incorporate the patient's neurological condition, number and location of metastases, tumor biology, extracranial disease, prior treatment, and available systemic therapies.

Symptoms of Brain Metastases

Symptoms depend on tumor size and location, and may include:

  • Headaches

  • Seizures

  • Speech or language difficulty

  • Weakness or numbness

  • Visual changes

  • Cognitive or personality changes

  • Balance or coordination problems

  • Nausea or vomiting from swelling or pressure

New neurological symptoms should prompt urgent evaluation.

How Brain Metastases Are Diagnosed

Evaluation often includes:

  • MRI of the brain with tumor protocols

  • Perfusion imaging and advanced sequences

  • Whole-brain or body imaging (CT/PET)

  • Review of tumor molecular profile

  • Assessment of functional networks when lesions are near critical areas

Dr. D’Amico frequently integrates structural and functional connectomics to guide decisions when tumors are close to motor, language, or cognitive networks.

Brain Metastasis Surgery

Connectomics-Guided Resection

Brain metastases often sit near important fiber tracts.
Dr. D’Amico uses connectomics to:

  • Identify network pathways around the tumor

  • Choose the safest surgical corridor

  • Identify and plan around speech, motor, sensory, and cognitive networks

  • Plan minimally disruptive approaches tailored to each patient

Awake and Asleep Brain Mapping

For selected tumors near language or other higher-order functional networks, awake mapping can allow real-time testing during surgery. Many brain metastases can be safely treated under general anesthesia using motor mapping, neuromonitoring, imaging, and connectomic guidance. The approach is individualized to the location of the tumor and the functions at risk.

Minimally Invasive Techniques

  • Keyhole craniotomies

  • Tubular/exoscopic corridors

  • Image-guided and fluorescence-assisted surgery

  • Laser Interstitial Thermal Therapy (LITT)

These methods aim to maximize safety, precision, and recovery. Dr. D’Amico offers minimally invasive resection, tubular corridor access, exoscopic visualization, and precision-guided approaches designed to reduce recovery time while maximizing tumor control.

Brachytherapy for Selected Recurrent Brain Metastases

For selected patients undergoing surgery—particularly for tumors that have previously received radiation—intracranial brachytherapy may provide another option for local treatment. GammaTile uses cesium-131 radiation sources placed within the surgical cavity at the time of tumor removal. Whether it is appropriate depends on prior radiation, tumor characteristics, and the multidisciplinary treatment plan.

Recurrent Brain Metastases and Radiation Necrosis

An enlarging lesion after stereotactic radiosurgery may represent recurrent tumor, radiation necrosis, or a mixture of both. Advanced imaging can help, but sometimes tissue diagnosis is necessary. Selected patients may benefit from surgical resection or minimally invasive treatment such as LITT, depending on the lesion's location, symptoms, prior treatment, and diagnostic uncertainty.

Multidisciplinary Treatment Beyond Surgery

Most patients benefit from coordinated treatment, which may include:

  • Stereotactic radiosurgery (SRS)

  • Fractionated radiation therapy

  • Brachytherapy (GammaTile)

  • Targeted systemic treatments (e.g., EGFR, ALK, BRAF, HER2 targeted drugs)

  • Immunotherapy

  • Chemotherapy

  • Clinical trials

Dr. D’Amico works closely with neuro-oncology and radiation oncology to build individualized treatment plans that prioritize both cancer control and quality of life.

Second Opinions for Brain Metastases

Patients frequently seek another opinion for:

  • Newly diagnosed brain metastases

  • Large or symptomatic metastases

  • Multiple brain metastases

  • Tumors considered high-risk or “inoperable” because of their location

  • Recurrent tumors after surgery or stereotactic radiosurgery

  • Uncertainty between radiation necrosis and tumor progression

  • Questions about surgery versus radiation

  • Tumors involving critical functional networks

A second opinion does not necessarily mean surgery will be recommended. The goal is to determine which combination of surgery, radiation and systemic therapy offers the most appropriate treatment strategy.

Serving New York City & the Tri-State Area

Care is provided at Lenox Hill Hospital on the Upper East Side (100 E 77th St, New York, NY 10075), with convenient access for patients in:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Dr. D’Amico’s program provides streamlined evaluation pathways for patients with new or active brain metastases.

Rapid Evaluation for Brain Metastases

Newly diagnosed and symptomatic patients can often be evaluated through the Brain & Spine Metastasis Program within 24–48 hours. Referring physicians may also contact the program directly for expedited review.

Request a Brain Metastasis Consultation or Second Opinion

If you or a loved one has been diagnosed with brain metastases: