How do you manage a recurrent brain metastasis in a surgical cavity that contains mixed radiation necrosis and viable tumor in the setting of prior SRS?  

This diagnosis is made at our center by combining MRI, MR perfusion, and PET data. Management depends on the presentation of the patient, if there is mass effect and/or neurological deficit then surgical re-resection is preferred. As a matter of interest, the pathology on the infrequent resections ...

In the setting of a region of the brain that has seen SRS, then surgical resection (for either tumor or necrosis), I would not personally recommend repeat SRS to the surgical cavity (which is now all or at least mostly normal brain that has already seen radiation). I do not think the risks of re-irr...