Brain metastases develop when cancer cells from another organ – such as the lung, breast, kidney, or skin – spread to the brain. They differ from primary brain tumors like gliomas or glioblastomas because they originate outside the central nervous system. This means: Even though the metastasis is located in the brain, it carries the typical cell characteristics of the primary tumor. The cancer cells usually reach the brain via blood vessels, more rarely through direct spread from neighboring tumors, e.g., in skull bone cancer. Since brain metastases have the same cell structures as the primary tumor, a tissue sample (biopsy) can help identify the primary tumor – even if it was previously unknown. On the other hand, examination of the brain metastases after long-term treatment of the primary tumor can provide important clues for treating the entire cancer disease: often a reason for surgery.
- Frequently affected primary tumors: Lung carcinoma, breast carcinoma, malignant melanoma, renal cell carcinoma, urothelial carcinoma.
- Metastases can occur singly or multiply (multiple brain metastases).
- Diagnosis of brain metastases is usually via MRI – in some cases additionally through a biopsy.
Brain metastases occur particularly frequently in patients with bronchial carcinoma (40–60%), breast cancer (15–20%), or malignant melanoma (10–15%). Renal cell carcinomas and urothelial carcinomas can also spread to the brain. In about 10 to 20% of cases, the primary tumor remains unknown despite intensive diagnostics.
The symptoms of brain metastases depend heavily on their location, size, and growth speed. Neurological deficits often occur suddenly. Initial signs should always be taken seriously:
- Headaches, often in the morning or position-dependent
- Nausea, vomiting, dizziness
- Seizures (epileptic attacks)
- Speech, vision, or movement disorders
- Cognitive limitations, personality changes, confusion
- Personality changes, e.g., lack of drive or aggressiveness
Important: These symptoms can also have other causes – a medical clarification is therefore essential.
Brain metastases generally grow faster than primary brain tumors such as gliomas. The growth rate depends on the primary tumor and its biology. Melanomas or small cell bronchial carcinomas often cause rapidly growing metastases. Early diagnosis and therapy are crucial for prognosis and quality of life.
The prognosis for brain metastases depends on many individual factors – including:
- the type and aggressiveness of the primary tumor,
- the number and location of the metastases in the brain,
- the general state of health,
- the response to therapy.
Thanks to modern diagnostic procedures and targeted treatment strategies – such as through a combination of radiation, surgery, and systemic therapy of the brain metastases – life prolongation and in some cases also stabilization or regression of symptoms can be achieved for many affected individuals.
With a well-controlled primary disease and limited metastasis, the prospects are significantly better today than just a few years ago. New therapies like immunotherapies or targeted therapies, which we use in neuro-oncology, also contribute to preserving quality of life and effectively treating the disease. Important here is an individual therapy plan within an experienced, interdisciplinary team – as is ensured at the Center for Neuro-Oncological Neurosurgery at Beta Klinik.
A fast and precise diagnosis is crucial to be able to act targetedly with brain metastases. At Beta Klinik Bonn, we combine modern imaging procedures with years of diagnostic experience and close interdisciplinary coordination – always with the goal of not only making the metastases visible but also deriving the best therapy options from it.
We rely on:
- Magnetic Resonance Imaging (MRI) with contrast agent – gold standard for localization, number, and size of metastases
- MR perfusion and FET-PET – for assessing metabolic activity and differentiation from scar tissue
- Targeted biopsy – for histological confirmation and determination of molecular markers, e.g., with unknown primary tumor
- Molecular pathological analysis – for selecting targeted therapies or studies
Decisive is not only whether a metastasis is present, but what it reveals about your illness and the next treatment strategy. For this, we take our time.
With pre-treated brain metastases, the crucial question often arises: Is it a tumor recurrence that requires renewed treatment, or merely treatment-related changes that make intervention unnecessary? Since imaging cannot always reliably make this distinction, an open biopsy creates clarity – and enables a secure basis for further therapy planning.
A tissue sample from the metastasis is particularly informative in many cases, as it reflects the current biological state of the tumor. Metastases can be genetically changed and differ from the characteristics of the primary tumor. The analysis of the fresh tissue therefore provides decisive clues for modern, targeted treatments or immunotherapeutic approaches.
In our center, we rely on state-of-the-art technologies to perform the open biopsy with maximum precision and safety. Using high-resolution image integration (MRI, perfusion, spectroscopy, FET-PET), we determine the optimal biopsy site, while a navigation system of the latest generation enables millimeter-precise guidance. Additionally, we use fluorescence-guided procedures like the REVEAL headlamp and the fluorescein technology specifically applied for metastases, which visualizes tumor tissue with previously unattained detail accuracy.
This ensures that high-quality tissue is obtained – sufficient for molecular pathological analyses, genetic tests, and the planning of innovative therapies. Simultaneously, intraoperative monitoring of neurological functions guarantees the highest safety during the procedure. Thus, the open biopsy for brain metastases makes a decisive contribution to initiating the individually best possible treatment and gaining valuable time in the fight against the tumor.
