Brain Metastasis Removal Surgery at Neurosurgical Clinic of University Hospital Rechts der Isar Munich

The neurosurgical intervention for brain metastases at the University Hospital Rechts der Isar in Munich represents a pinnacle of German high-tech medicine, where surgical oncological precision is fused with advanced intraoperative neuro-imaging. At this clinic, the removal of secondary tumors is not viewed as a standalone event but as a highly personalized procedure integrated into the interdisciplinary Roman Herzog Comprehensive Cancer Center. The surgical philosophy here centers on function-preserving radicality, aiming to achieve complete resection of the metastatic lesion while using real-time mapping to protect eloquent brain regions responsible for speech, motor skills, and cognition. A hallmark of the Rechts der Isar approach is the routine implementation of intraoperative MRI (iMRI) and high-field neuronavigation. Before the first incision is made, a digital twin of the patient’s brain is created using 3D structural data. During the operation, neurosurgeons use the iMRI to scan the brain while the patient is still on the table, allowing them to detect microscopic remnants of the metastasis that might be invisible to the naked eye. This is often supplemented by 5-ALA fluorescence-guided surgery, in which a specialized dye causes tumor cells to glow under specific blue light, providing sharp visual contrast between the malignant tissue and the healthy brain parenchyma. For metastases located near critical functional pathways, the clinic specializes in awake craniotomy and continuous intraoperative neuromonitoring (IONM). This allows the surgical team to interact with the patient during resection, ensuring vital neurological functions remain intact in real time. The clinic also employs ultrasonic aspirators, which use high-frequency vibrations to gently fragment and aspirate tumor tissue, minimizing mechanical traction on the delicate cerebral vessels. This microscopic precision is essential for preventing post-operative deficits and ensuring that the patient can transition quickly to the next phase of their oncology treatment. Post-operative care is managed within a dedicated neurosurgical intensive care unit, where the focus shifts to preventing cerebral edema and optimizing neurological recovery. Because brain metastases are often part of a systemic disease, the surgical team works in immediate proximity to the clinic’s specialized radiation oncologists and molecular pathologists. This ensures that the resected tumor tissue is analyzed for genetic markers that could qualify the patient for targeted immunotherapies. By combining this aggressive surgical technological suite with a deep academic research foundation, the neurosurgical facility at Rechts der Isar provides a quaternary-level gateway for patients facing complex intracranial secondary malignancies.