BRAIN METASTASES (NYC)

Advanced Surgical Management • Multidisciplinary Oncology • Connectomics-Guided Precision

Overview

Brain metastases—cancers that spread to the brain from other parts of the body—are the most common type of brain tumor in adults. They often arise from lung, breast, melanoma, renal, and gastrointestinal cancers, but can occur with many tumor types. Managing brain metastases requires experience, surgical precision, and seamless collaboration with oncology, radiation therapy, and systemic treatment teams.

As a neurosurgical oncologist at Lenox Hill Hospital and Director of Northwell Health’s Brain & Spine Metastasis Program, Dr. Randy S. D’Amico specializes in the evaluation and surgical treatment of brain metastases, including complex lesions, recurrent tumors, and cases previously considered inoperable. His approach prioritizes preservation of neurologic function, rapid access for urgent cases, and clear decision-making for patients and families.

When Surgery Helps

Surgery for brain metastases is often recommended when:

  • A tumor is large or causing mass effect

  • There is swelling, midline shift, or hydrocephalus

  • A biopsy is needed for diagnosis

  • A single or limited number of lesions can be safely removed

  • The metastasis is resistant to radiation or systemic therapy

  • A tumor previously treated with radiation enlarges and diagnosis of radiation necrosis vs. progression is unclear

  • Rapid symptom relief is necessary (headache, weakness, speech difficulty)

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

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.

Surgical Approach

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

  • Avoid speech, motor, sensory, and cognitive disruption

  • Plan minimally disruptive approaches tailored to each patient

Awake Mapping (When Needed)

For tumors near language or motor areas, awake surgery may allow real-time testing to preserve essential function.

Minimally Invasive Techniques

  • Keyhole craniotomies

  • Tubular/exoscopic corridors

  • Image-guided and fluorescence-assisted surgery

  • Laser Insterstitial 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.

Recurrent Metastases or Post-Radiation Lesions

Patients with tumors after prior radiation or systemic therapy often require nuanced evaluation. Surgery may help distinguish:

  • Radiation necrosis

  • Tumor progression

  • Treatment-related changes

This can dramatically alter systemic therapy and radiation planning.

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

Patients often seek Dr. D’Amico for:

  • Evaluation of tumors labeled “inoperable”

  • Confusion between radiation necrosis and progression

  • New or multiple metastases

  • Metastases near eloquent cortex

  • Recurrent lesions after surgery or SRS

  • Desire for connectomics-guided surgical planning

  • Urgent symptom change (weakness, worsening headaches, new seizures)

Second opinions are often available quickly, especially for symptomatic or new diagnoses.

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.

Next Steps

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

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to Conditions Treated for additional diagnoses