Excision of a primary pulmonary neoplasm and solitary cerebral metastases was done on 22 patients. Six patients had metastatic tumor removed on 2 occasions and there was 1 operative death in 28 craniotomies. Seven of 22 patients (32%) survived 1 yr following craniotomy and were free of significant symptoms for 1 yr. Survival for at least 9 mo. and freedom from significant symptoms was achieved in 12 patients (55%). Relief of severe neurologic symptoms for a minimum of 3 mo. was achieved in 17 patients (77%). The overall 1-yr survival rate was 45% and the average survival period was 14 mo. with 3 patients still living. The following factors had a favorable bearing on the outcome: stage I lung cancer at pulmonary resection, whole brain radiation therapy and a longer interval between pulmonary resection and cerebral metastases. The experience encourages pursuit of an aggressive surgical approach to pulmonary neoplasms and solitary cerebral metastases.