Intracranial metastases. Management and the place of the CT scan in patients who are treated with surgery only.

Five hundred and fifty-three patients with intracranial metastases were analysed, before and after the availability of CT scanning, from three neurosurgical centres. A further analysis of 318 patients, who had a total excision carried out, was made from the six groups (i.e. posterior fossa or craniotomy in each centre) before and after CT scanning was available. A statistically significant reduction in the excision rate occurred in one group after the CT scan was available, and the very small number of patients who survived for more than 12 months was not significantly increased in the groups who had a CT scan carried out. Median survival in the various groups, whether analysed on a unit basis or with all three units combined, was not only poor (two to five months) but was not significantly better in the groups investigated with CT scanning. It would therefore appear that the use of the CT scan has not enabled a more careful selection of patients suitable for excision to take place or improved the median survival. Thus, by implication, and from the evidence of the literature, a more intensive preoperative investigation should be considered in order to exclude possible extracranial metastases and appraise the place of cranial irradiation.