OBJECTIVE: To summarize the experience of scalp linear small incision bone window craniotomy for brain metastases and improve the efficacy of this type of tumor. METHODS: To summarize the comprehensive evaluation of operation time, hospitalization time and mental status of 32 patients with surgically resected brain metastases over 4 years. RESULTS: The use of this method can shorten the operation time and hospitalization time, reduce the patients’ fear and actively cooperate with the doctors to complete the steps of comprehensive treatment. CONCLUSION: Brain metastasis is an advanced manifestation of malignant tumor, and comprehensive treatment such as surgery, radiotherapy and chemotherapy is the main treatment; surgical resection of brain metastasis can relieve clinical symptoms and create conditions for later comprehensive treatment. Scalp linear small incision craniotomy with bone window has the advantages of short operation time, small trauma, quick recovery and light psychological burden for patients, which is an ideal method for treating brain metastases. Brain metastasis is a common intracranial tumor and is an advanced manifestation of malignant tumor. Taking individualized comprehensive treatment is the main treatment method for brain metastases; minimally invasive surgery can alleviate or avoid patients’ pessimism and fear, and optimistically and actively cooperate with doctors to complete each step of comprehensive treatment. This paper intends to summarize the experience of 32 patients with brain metastases in our department in the past 4 years who were resected by craniotomy with small scalp incisions, in order to improve the efficacy and survival quality of patients with these advanced tumors. 1. Data and methods (1) General data 32 patients with brain metastases admitted to our department for surgery from January 2004 to August 2008 were selected; their ages ranged from 32 to 74 years old, with an average of 56 years old; 23 cases were male and 9 cases were female; their disease duration ranged from 1 to 12 months. Clinical manifestations: headache in 30 cases, accounting for 94%; nausea and vomiting in 20 cases, accounting for 63%; optic papilledema in 18 cases, accounting for 56%. Neurological symptoms and signs: hemiparesis in 13 cases (41%), seizures in 7 cases, aphasia in 2 cases, psychiatric symptoms in 4 cases, and ataxia in 5 cases. The CT and MRI scans showed that the tumor diameter ranged from 1.8 cm to 5.5 cm; the cranial CT showed a well-defined circular or oval lesion with low, equal or mixed density and obvious edema of the surrounding brain tissues, and the tumor entity was obviously enhanced on the enhanced scan, with necrosis and liquefaction in the center of the tumor. Cranial MRI showed well-defined tumor with low or slightly low signal in T1-weighted image, high or mixed high signal in T2-weighted image, and obvious enhancement with uneven boundaries of round-like or oval-shaped with liquefied necrosis in the center after enhancement scan. The brain metastases were single in 26 patients, 14 in frontal lobe, 7 in parietal lobe, 5 in occipital lobe and 4 in cerebellum; 6 in multiple brain metastases. (2) Surgical method In 32 patients with brain metastases, a linear scalp incision was made with an incision length of 6.0cm-8.0cm, and the scalp was cut to reach the outer plate of the skull. The dura mater was suspended around the window, and the dura mater was cut in the shape of “X” to enter the skull and remove the tumor in the same way as the bone flap craniotomy. After removing the tumor, the dura was repaired and sutured, the bone window was closed with titanium mesh, and the scalp was sutured. 2. Results The average operation time of this group of patients was shortened by 0.5~1.0 hours compared with traditional craniotomy, and the postoperative hospitalization days were shortened by 2~4 days, and the operation cost was less than that of the same period of inpatient surgery by RMB 1000~3000. Among the 32 patients in this group, all of them were clinically followed up, and the survival period ranged from 5 to 48 months, with an average of 12 months; 24 patients survived within six months after surgery, accounting for 75%; among them, 6 cases recurred in situ within one year after surgery, and a second surgical resection was performed. After surgery, 28 cases were treated with radiotherapy, and the average survival period was 10 months, the longest one was 38 months; 25 cases were treated with surgery + radiotherapy + chemotherapy, and the average survival period was 13 months, the longest one was 48 months. 3. Discussion Brain metastases are common intracranial tumors and are an advanced manifestation of malignant tumors; they account for 10%-15% of clinical brain tumor patients, and 20%-40% of cancer patients will eventually develop brain metastases [1,3]. Brain metastases require individualized and comprehensive treatment that takes into account the different conditions of each patient. Considerations include the patient’s age, general condition, neurological functional status, primary tumor site, presence of extracranial multiple metastases, and the number and location of brain metastases [2]. When patients have life-threatening increased intracranial pressure, intracerebral metastases can be removed first, and other treatments can be performed after the condition is stabilized. The indications for surgery include: (1) single brain metastases of young age and in good general condition; (2) superficial metastases located in non-functional areas; (3) no metastases in other parts of the body, and the primary foci have been resected without local recurrence; (4) brain metastases with life-threatening intracranial pressure increase, and if the metastases can be surgically removed, the condition can be relieved and the patient’s survival time can be prolonged [1]. Brain metastases are clearly defined with the surrounding brain tissues, and the tumor and necrotic tissues should be completely removed during surgery. In case of severe edema in the brain tissue around the brain metastases, part of the edematous brain tissue should also be removed to facilitate postoperative recovery. In the resection of intracranial tumor, most of the tumors are removed by “U” shaped scalp incision and bone flap window, which requires formation of skin flap, skull drilling and then bone window with milling knife or wire saw, and placement of subcutaneous drainage tube. It is not conducive to the recovery of advanced tumor patients because it increases the fear and psychological burden of patients to a great extent. In modern comprehensive treatment of tumors, humanistic care and psychological guidance are an important part of comprehensive treatment and are gaining more and more attention [4]. For patients with brain metastases, which are in the advanced stage of tumor, the overall treatment effect is not good, how to make this part of patients reduce pain, improve survival quality, reduce patients’ psychological burden, and make patients enhance their confidence to overcome the disease to complete the comprehensive treatment is very important, from this perspective, minimally invasive surgery is the best choice for brain metastases treatment. The advantages of adopting a small scalp incision are as follows: (1) the scalp incision is shortened to reduce scalp bleeding and avoid the occurrence of postoperative subcutaneous fluid; (2) the bone window formation step can usually be completed 10 minutes after the operation starts, which greatly shortens the craniotomy time compared with the traditional skin flap and bone flap formation, and reduces the amount of anesthesia and drug metabolism burden, which is readily accepted by patients; (3) the surgical field can fully meet the needs of tumor removal; (4) the postoperative incision can fully meet the needs of tumor removal. (3) the surgical field can fully meet the needs of tumor removal; (4) the incision heals quickly after surgery, usually 5 days to remove the stitches, reducing the number of hospital days and hospital costs; (5) the titanium mesh directly repairs the cranial bone window defect, avoiding the bone flap instability caused by the bone flap repositioning method; (6) the patient’s psychological burden is reduced, and it is easy to cooperate with the doctor to complete the various steps of comprehensive treatment in a happy mood. The above methods we adopted are applied to clinical practice with satisfactory results.