Epidemiology

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Improved neuroimaging has revealed that patients with cerebral metastases outnumber those with primary brain tumors. At autopsy,

25% of cancer patients harbor intracranial metastases [2]. Cerebral metastases - those involving the brain parenchyma itself - occur in about 15% of patients with solid systemic tumors [2]. This prevalence is likely to increase as the proportion of elderly in the population increases, as diagnostic neuroimaging becomes even more sensitive and as patients with cancer live longer.

The pattern of metastasis to the CNS varies with tumor type. Intracranial metastases include those to the skull, meningeal spaces and brain parenchyma. Many skull metastases originate from breast and prostate cancer [3]. Metastases to the pituitary gland are often from breast cancer.

Lung and breast cancer, followed by melanoma, genitourinary cancer and gastrointestinal cancer, are the most common histolog-ical types of cerebral metastasis (Table 16.1). The risk of developing cerebral metastasis is highest with malignant melanoma, followed by lung and breast cancer (Table 16.2). Among the types of lung cancer, small cell carcinoma and adenocarcinoma more frequently spread to the brain than does squamous cell carcinoma.

Most cerebral metastases spread to the brain hematogenously. Tumor cells distributed arte-rially commonly originate from the lung, either from a primary lung tumor or from an extrapulmonary primary that has metastasized to the lung. Less commonly, venous routes are taken. The anastomotic pelvic-vertebral venous plexus

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