How would you approach treatment of a posterior fossa metastasis with surrounding vasogenic edema causing mass effect on the 4th ventricle in an asymptomatic patient?  

Agree with Dr Chao's answer above on this. In our institution, our treatment of these lesions (in the context of limited mets and no LMD) falls into 3 categories: -preop SRS, usually 15Gy/1fx to the lesion followed by resection that day, sometimes followed by post-op SRS if lesion still felt to be ...

In the setting of relatively limited number of brain metastases, there are 2 approaches. 1) Surgical resection with neoadjuvant or adjuvant SRS 2) SRS alone If surgical resection is done, I favor doing the SRS neoadjuvantly to minimize the risk of leptomeningeal spread which seems to be higher in...

I agree with @Samuel T. Chao and @Evan Thomas. Along with @Evan Thomas, I prefer fractionated SRS for this situation. I did have one patient require a shunt after SRS-induced edema of a lesion abutting the 4th ventricle. While this would be considered a high grade toxicity, it was fortunately r...