Stereotactic Radiosurgery for Brainstem Metastases: A Case Series and a Brief Literature Review

Brainstem metastases (BSM) represent a rare but clinically significant subset of brain metastases, often associated with severe neurological impairment and limited treatment options due to their location near critical neural structures. Stereotactic radiosurgery (SRS) has emerged as a safe and effective non-invasive alternative, yet dose guidelines remain non-standardized. This article presents a series of three patients with BSM treated at our institution using fractionated SRS (21 Gy in 3 fractions), followed by a literature review. All cases demonstrated initial clinical and radiological responses, with manageable toxicity profiles. One patient achieved a complete response with no adverse events, another experienced radionecrosis requiring corticosteroids, and the third showed intracranial progression post-treatment. These cases highlight the complexity of managing BSM and reinforce the role of SRS in achieving local control while preserving neurological function. Our findings align with existing literature supporting SRS as a viable option for BSM, emphasizing the importance of individualized treatment planning based on tumor characteristics and prior therapies. Further research is warranted to optimize dose protocols and integrate systemic treatments to improve long-term outcomes.