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Brain metastases (BrM) are the most common brain tumor in adults, affecting some 8 to 14 people per 100,000 population, and up to 20% of patients with cancer will develop clinically-or radiographically-apparent BrM. 1–5 Some autopsy studies estimate the true incidence as higher still, up to some 30% of patients with cancer, 6 and this represents a growing concern for oncologists and neurosurgeons. The most common primary brain-metastatic malignancies are lung and breast carcinomas and melanoma, largely reflecting their extra-central nervous system (CNS) incidence, and colorectal and renal cell carcinomas are also seen in increasing numbers. 3 Although improvements in CNS and extracranial systemic control have resulted in steady gains in both survival and morbidity, the prognosis for BrM remains poor with a median survival of between 4 and 8 months depending on cancer type 3, 7, 8 and a 5-year …