Neuro-Oncology & Brain Tumor Care
Multidisciplinary management of primary and metastatic central nervous system malignancies, molecular neuropathology, and neurosurgical innovations.
Overview
Neuro-oncology is the specialized field dedicated to primary neoplasms of the brain and spinal cord, central nervous system (CNS) metastases originating from systemic solid tumors, and neurological complications of cancer therapies. Management requires integrated multimodal care between neuro-oncologists, neurosurgeons, radiation oncologists, neuroradiologists, and neuropathologists.
Primary vs. Secondary CNS Tumors
| Tumor Classification |
Histological Types |
Key Molecular Biomarkers |
Standard Therapeutic Interventions |
| High-Grade Gliomas (Glioblastoma, Astrocytoma Grade 4) |
Diffuse infiltrating astrocytic neoplasms |
IDH1/2 wildtype vs. mutant, MGMT promoter methylation, TERT promoter mutations, EGFR amplification |
Maximal safe resection → Stupp Protocol (Concurrent Radiation + Temozolomide) → Adjuvant Temozolomide + Tumor Treating Fields (TTFields) |
| Oligodendrogliomas (Grade 2-3) |
Infiltrating gliomas with characteristic perinuclear halos |
IDH mutation and mandatory concurrent 1p/19q chromosomal co-deletion |
Surgical resection followed by Radiotherapy and PCV Chemotherapy (Procarbazine, Lomustine/CCNU, Vincristine) |
| Brain Metastases (Secondary CNS) |
Metastatic dissemination from Lung (NSCLC), Breast, Melanoma, Renal Cell, Colorectal |
HER2, EGFR, ALK, BRAF V600E mutations matching primary tumor genetics |
Stereotactic Radiosurgery (SRS / Gamma Knife), CNS-penetrant targeted inhibitors (Osimertinib, Tucatinib, Dabrafenib) |
| Meningiomas & Nerve Sheath Tumors |
Arising from arachnoid cap cells and cranial/spinal nerves |
NF2 mutations, TRAF7, KLF4, AKT1 alterations |
Observation, microsurgical excision, stereotactic fractionated radiation |
Neurosurgical Innovations
- Maximal Safe Resection: Removing the maximal possible enhancing tumor volume while preserving functional motor, language, and sensory eloquence.
- Fluorescence-Guided Surgery (5-ALA / Gliolan): Oral administration of 5-aminolevulinic acid accumulates as fluorescent protoporphyrin IX inside malignant glioma cells, illuminating tumor margins under blue light.
- Intraoperative Neuronavigation & MRI: Real-time stereotactic spatial tracking fused with intraoperative MRI to compensate for brain shift during resection.
- Awake Functional Craniotomy: Direct cortical and subcortical electrical stimulation mapping of language and motor tracts during active patient communication.
Systemic & Biophysical Therapies
- Alkylating Chemotherapy (Temozolomide): Lipophilic oral agent crossing the blood-brain barrier (BBB); efficacy significantly enhanced in tumors with epigenetic MGMT promoter hypermethylation.
- Tumor Treating Fields (Optune / TTFields): Non-invasive alternating electrical fields (200 kHz) disrupting mitotic spindle tubulin polymerization during cancer cell division.
- Anti-Angiogenic Therapy (Bevacizumab): VEGF neutralization reducing severe tumor-associated vasogenic cerebral edema and radiation necrosis.
Neurological symptom management, including seizure prophylaxis, antiepileptic drug selection, corticosteroid weaning (Dexamethasone), and cognitive rehabilitation, is integral throughout the patient journey.
