Table 1 Indications for neurosurgery in the presence of malignancy [35]

Surgical Indications

• Pain due to mechanical compression of pain producing structures or clear instability

• Symptomatic mechanical compression of neurostructures (neurological deficit)

• Rapidly progressing neurological deficit due to mechanical compression

• Unknown primary tumor with clearly defined metastatic involvement of the spine

• Radioresistant tumor

• Neurological deterioration or increasing pain during or after radiotherapy (should be avoided by a careful evaluation of the tumor potential before irradiation is decided)