Background: This local study aims to address gaps in understanding factors influencing local control in patients with brain metastases treated with adjuvant Gamma Knife Radiosurgery Methods: A retrospective analysis used a local, prospectively kept Gamma Knife database. Sixty-three patients treated with GK SRS were included. Variables included demographics, tumor characteristics, SRS parameters, and outcomes such as local control, recurrence, survival, and adverse effects. Results: At 12 months, local control was 66.7%, decreasing to 57.1% at 24 months. Distant progression occurred in 58.7%, leptomeningeal disease in 15.9%, and adverse radiation effects in 20.6%. The 12-month survival rate was 63.5%, dropping to 38.1% at 24 months. None of the examined factors significantly influenced local control. Local progression within the first year of treatment was associated with a 5.0-fold increased risk of death at 24 months, while distant intracranial progression showed a 6.0-fold increased risk at 12 months and an 8.2-fold increased risk at 24 months. Conclusions: While the parameters we examined were not linked to local control, intracranial progression significantly impacted survival. This real-world cohort provides valuable insights into the challenges of managing brain metastases. Further work is needed to refine the current treatment strategies for intracranial progression and ultimately improve survival outcomes.