Patient description: The patient is a 41-year-old man and a known case of Acromegaly who underwent transsphenoidal surgery 4 months ago. He came to the clinic for the follow up lab studies after his primary resection surgery. His lab study shows the IGF-1 level of 4.5 ULN adjusted by sex and age. His random GH level is 4 ug/L. The recent brain MRI confirmed the residual pituitary tumor. His past medical history is only significant for acromegaly due to pituitary adenoma and the recent surgery. After his surgery he takes only vitamin D and multivitamins.

Clinical trial eligibility criteria: eligible ages (years): 0.0-999.0,  Brain Neoplasms Neoplasm Metastasis Patients must: 1. be 21 years of age or older. 2. have a histologically confirmed primary malignancy. 3. be able to undergo an MRI scan of the brain. 4. have one to three intraparenchymal brain metastases as identified on a brain MRI scan with intravenous contrast. 5. have contrast enhancing tumor(s) that are well circumscribed and less than or equal to 4.0 cm in any dimension. 6. be appropriate for either procedure as determined by both a neurosurgeon and a radiation oncologist  Patients must not: 1. have tumor(s) in the midbrain, pons, or medulla patients undergoing surgical resections in these areas are highly likely to develop significant neurological deficits or death. 2. have tumors within 10 millimeters of the optic apparatus (nerves and chiasm) or the area postrema patients undergoing SRS to these areas are at significant risk of developing permanent blindness or intractable nausea. 3. be poor operative candidates from an anesthetic point of view secondary to other major medical illnesses the risk of undergoing general anesthesia outweighs the potential benefit of undergoing surgical resection of a brain metastasis. 4. have a coagulopathy demonstrated by an abnormal prothrombin time, activated partial thromboplastin time, or thrombocytopenia (platelet count less that 150,000 platelets/mm3) the risk of developing uncontrollable intra-operatively bleeding outweighs the potential benefit of undergoing surgical resection of a brain metastasis. 5. have radiographic or cerebrospinal fluid specimen evidence of widespread leptomeningeal metastasis neither surgery nor SRS is a useful treatment modality for this condition. 6. significant psychiatric impairments which, in the opinion of the investigators, will interfere with the proper administration or completion of the protocol self explanatory. 7. acute or untreated infections (viral, bacterial or fungal) patients with active infections are highly likely to have spread of their infections to the brain as a result of a craniotomy. 8. be pregnant at the time of the randomized treatment general anesthesia and surgery may subject the fetus to unacceptable risks. Also, the NIH does not offer full obstetrical services in the event that medical care to the mother and/or fetus is required. Pregnant women presenting with brain metastases will be referred to facilities offering OB/GYN services. 9. be prisoners or other institutionalized individuals these individuals are at risk of being susceptible to undue influences to participate in a research protocol against their free will. 10. have a diagnosis of germ cell tumor, lymphoma or small cell lung cancer