The patients have to endure headaches and other neurological symptoms for several weeks until the tumor shrinks in size. Although tumors in the motor and speech cortex and the brain stem cannot be removed safely, surgical intervention is the first choice of treatment for large solitary tumors in other sites of the brain. Surgery is carried out for multiple brain tumors if all tumors can be removed by a single craniotomy or by plural craniotomies without changing the patients' position during surgery. Surgery is also recommended for the largest one of multiple tumors which is threatening the patient's life. Most brain metastases exist subcortically and cannot be seen on the surface of the brain.
Intraoperative ultrasonography is very useful.
It provides information on the precise location of the tumor and optimal site of corticotomy. In order to avoid dissemination of cancer cells, the tumor and surrounding reactive tissues should be removed en bloc if it is possible. However, whole brain irradiation often induces neurological deterioration, dementia or both. The patients develop progressive dementia, ataxia, and urinary incontinence several months after radiotherapy. In such patients neuroradiological imaging often reveals cortical atrophy and hypodense white matter.