Summary:Brain metastases are the most common neurological complication of systemic cancer, a serious cause of morbidity and mortality, and a significant challenge for neurosurgeons and neurooncologists. They outnumber all other intracranial tumors combined and, with advances in technology and treatment of systemic cancer, are on the increase as cancer patients live longer. This review discusses the factors that influence their occurrence in the central nervous system, namely primary cancer, age, and sex; clinical aspects of presentation; and the basic diagnostic modalities, computed tomography and magnetic resonance imaging. These aspects are presented along with an emphasis on the efficacy of different treatment options, including recent information that broadens the scope of surgical implications. Although radiation therapy remains the main therapeutic modality, surgical excision has increasingly shown advantages in certain settings, as has stereotactic radiosurgery. Chemotherapy is less effective, but its advantages are reviewed, as are the implications of recurrent metastases. This review concludes with a separate section on the special concerns of leptomeningeal metastases.