Background: The optimal treatment for patients with non-small cell lung cancer (NSCLC) with neurologically symptomatic, synchronous brain metastasis still remains controversial. The aim of this study was to analyze our experience with surgical treatment in these patients. Methods: The study was a retrospective review of 25 patients presented with neurologic symptoms, synchronous and multiple or solitary brain metastasis from NSCLC between Apr, 2006 and Dec, 2011. Patients were divided into two groups according to performing neurosurgery for brain metastasis: surgical treatment group (n=12) and non-surgical treatment group (n=13). We compared surgical group with non-surgical group and analyzed overall survival, clinical course, prognostic factors and treatment primary tumor and brain metastasis between two groups. Results: The mean age of the patients was 65.8 years. The histological types included 18 adenocarcinomas, 4 squamous cell carcinoma, 3 NSCLC-not otherwise specified. 11 patients of surgical group received upfront neurosurgical resection for brain metastasis followed by WBRT or stereotactic radiosurgery and 10 patients of non-surgical group received WBRT or stereotactic radiosurgery only. There was no significant difference in overall survival among two groups (surgical group, 11.6 months versus non-surgical group, 10.5 months, respectively; P=0.14). Conclusion: Patients with brain metastases, presenting with neurologic symptoms, showed no survival benefit from combined treatment with neurosurgical resection, although local brain metastasis was improved.