Brain metastases are treated with surgery, radiotherapy, radiosurgery, and chemotherapy. In this review, recently published studies concerning different treatment strategies are presented with respect to solitary lesions, multiple metastases, and recurrent tumor growth. Selection criteria for the appropriate therapy are: control of the primary tumor, extent of extracerebral metastases, time interval between diagnosis of the primary tumor and the development of cerebral lesions, number of cerebral metastases, Karnofsky performance scale score, and age. Treatment approaches were evaluated with respect to median survival time and quality of life. A singular brain metastasis can be treated with surgery or with radiosurgery. Especially when the primary tumor is under control, there are few extracerebral lesions which are stable, the Karnofsky performance scale score is above 70, the lesion is larger than 3 cm in diameter and surgically accessible surgery is the treatment of choice. Postoperative adjuvant radiotherapy may delay relapse. Median survival time ranges between 10 to 18 months. Radiosurgery can be applied in lesions smaller than 3 cm in diameter and is the treatment of choice in lesions which are surgically not accessible. Multiple metastases are treated either by conventional radiotherapy, radiosurgery or surgery. Commonly, no more than 3 lesions are approached by either surgery or radiosurgery. Median survival time ranges between 6 to 9 months for both treatment concepts, but without therapy only is 4-6 weeks. According to the clinical and neurological condition of the patient, recurrent brain metastases can be treated by operation, reirradiation, or radiosurgery. The efficacy of chemotherapy depends on the chemosensitivity of the primary tumor and the ability to penetrate the blood- brain barrier. Long-term survivors with cancer disease encourage to perform active treatment strategies.