The results of combined surgical resection of brain metastasis and primary lung cancer from January 1976 to April 1986 were evaluated. In all cases the brain metastasis was single and synchronous and was resected first. There were 20 men and one woman, with an average age of 53 years. All patients initially had neurologic symptoms related to an intracranial mass. In 19 patients the primary lung cancer was roentgenologically visible, but in two the lesion was recognizable only by bronchoscopy. There were no operative deaths. Nine of 21 patients had a poor postoperative course and died during the first 6 months. The combined surgical approach improved the short-term survival rate in four patients, who died 11, 12, 18, and 21 months after the thoracic operation. In six patients (28.5%) survival for more than 2 years was obtained (three died after 27, 30, and 40 months, three are alive after 25, 28, and 48 months). Two others patients are alive and well 4 and 16 months after the thoracic operation. Synchronous onset of brain metastasis from lung cancer does not necessarily contraindicate combined operations, which can provide long-term survival in selected patients. The absence of mediastinal node metastasis is a favorable prognostic factor. Computed tomographic screening of the brain improves patient selection.