转移瘤是影响中枢神经系统最常见的恶性肿瘤，约有20-40％的实体系统性肿瘤患者会出现。本综述的目的是讨论现代多学科治疗方法中神经外科手术的作用。一组由神经外科医生、神经学家和放射肿瘤医生组成的专家小组对诊断和治疗脑转移瘤的神经外科手术进行了选择性的文献综述，其中包括原始研究、荟萃分析和系统综述等。然而，缺乏前瞻性随机研究。 根据回顾性病例系列，国际指南推荐对于未知或可能存在系统性肿瘤疾病的病例、可能存在肿瘤复发的病例以及针对主要和继发性肿瘤分子异质性考虑的靶向治疗评估，如有需要，应进行组织病理学和分子诊断检查，如有需要则采用立体定向导航技术。手术切除对于治疗多达三种占据空间的脑转移瘤尤为有价值，特别是为了达到临床稳定状态以便继续非手术治疗。对于囊性转移瘤，立体定向穿刺和放射治疗的结合可能会有所帮助。髓膜癌也可以通过室内导管系统进行脑脊液内药物治疗。脑室腹腔分流术是治疗肿瘤相关性脑积水的有效选择。神经外科手术在脑转移瘤的多模态治疗中具有核心重要性。随着更有效的放射技术和新的靶向治疗和免疫治疗方法的出现，神经外科手术干预的适应症将进一步得到明确。

Metastases are the most common malignant tumors affecting the central nervous system and occur in 20-40 percent of patients with solid systemic tumors. The aim of this review is to discuss the role of neurosurgical procedures in a modern, multidisciplinary treatment approach.An expert panel of neurosurgeons, neurologists, and radio-oncologists conducted a selective literature review on neurosurgical interventions for the diagnosis and treatment of cerebral metastases. Original articles, meta-analyses, and systematic reviews were included.There is a lack of prospective randomized studies. Based on retrospective case series, international guidelines recommend the harvesting (if required, stereotactically guided) of tissue for histological and molecular diagnosis in cases of unknown or possibly competing underlying systemic malignant diseases, in cases of suspected tumor recurrence, and with regard to the evaluation of targeted therapies taking into account molecular heterogeneity of primary and secondary tumors. Surgical resection is particularly valuable for the treatment of up to three space-occupying cerebral metastases, especially to achieve clinical stabilization to allow further non-surgical treatment For cystic metastasis, a combination of stereotactic puncture and radiotherapy may be useful. Meningeal carcinomatosis can be treated with intrathecal medication via an intraventricular catheter system. Ventriculo-peritoneal shunts represents an effective treatment option for patients with tumorassociated hydrocephalus.Neurosurgical procedures are of central importance in the multimodal treatment of cerebral metastases. The indications for neurosurgical interventions will be refined in the light of more effective radiation techniques and systemic treatments with new targeted therapeutic approaches and immunotherapies on the horizon.