Brain and Spinal HTR Cover.indd 2 

This pamphlet was written and published by 

the National Institute of Neurological Disorders 

and Stroke (NINDS), the United States’ leading 

supporter of research on disorders of the brain 

and nervous system, including brain and spinal 

cord tumors. NINDS, one of the U.S. Government’s 

National Institutes of Health in Bethesda, Maryland, 

is part of the Public Health Service within the 

U.S. Department of Health and Human Services. 

NINDS health-related material is provided for 

information purposes only. Advice on the treatment 

or care of an individual patient should be obtained 

through consultation with a physician who has 

examined that patient or is familiar with that 

patient’s medical history. 
Table of Contents 

Introduction ............................................. 1



What are brain and spinal cord tumors? ..... 1



Overview of the brain and spinal cord ........ 2



CNS Tumor FAQs ...................................... 5



What are benign and malignant tumors? ..... 5



What are primary and metastatic tumors?... 5



What causes CNS tumors?....................... 6



Who is at risk? ..................................... 7



How many people have these tumors?......... 8



How are tumors graded? ......................... 8



What are the possible symptoms? .............. 9



How are CNS tumors diagnosed? ..................12



How are brain and spinal cord tumors treated?..15



Neurosurgery......................................16



Radiation therapy ................................19



Chemotherapy.....................................23



What are the different CNS tumors and 
 

tumor-related conditions? ...........................25



What is the prognosis?................................34



What research is being done? .......................35



Where can I get more information?................47



Glossary .................................................52


ii

Introduction 

A diagnosis of a brain or spinal cord tumor brings 

uncertainty and worry to you and your friends and 

family. It’s easy to become overwhelmed by a new 

world of tests, technology, and treatments that you 

may know little or nothing about. 

This guide will give you a better understanding 

of brain and spinal cord tumors, their treatment 

options, and the latest research to find safer, more 

effective ways to diagnose and treat them. You can 

take the best care of yourself by learning about 

your diagnosis and discussing it with your doctors. 

What are brain and spinal cord tumors? 

Brain and spinal cord tumors are found in the 

tissue inside the skull or the bony spinal column 

which make up the central nervous system (CNS) .

1 

A tumor is a mass of normal or abnormal cells that 

form a new growth or is present at birth (congenital). Tumors occur when genes that regulate cell 

growth become damaged or mutated, allowing 

cells to grow and divide out of control. Tumors 

can form anywhere in the body. 

Depending on its type, a growing tumor can kill 

healthy cells or disrupt their function. It can move 

or press on sensitive tissue and block the flow of 

blood and other fluid, causing pain and inflammation. A tumor can also block the normal flow 

of electricity in the brain or nerve signaling to 

and from the brain. Some tumors cause no 

trouble at all. 

1		A Glossary of terms and their specific meanings is found at the end of 

this guide. 

1 
 

 

2 

There are more than 120 types of brain and spinal 

cord tumors. Some are named by the type of cell 

in which they start (such as glioma) or location 

(such as meningioma, which form in the lining 

of the brain and spinal cord). 

Overview of the brain and spinal cord 

The following overview explains how the CNS 

works and what happens when a tumor is present. 

The brain has three major parts: 

•	 brain stem—This lowest part of the brain 

(above the neck) connects to the spinal cord and 

relays information between the brain and the 

body using bundles of long nerves. It controls 

basic life-sustaining functions, including blood 

pressure, heartbeat, breathing, consciousness, 

swallowing, and body temperature. 

•	 cerebrum—This largest and outermost part of 

the brain processes information from our senses 

to tell the body how to respond. It controls 

functions including movement, touch, judgment, learning, speech, emotions, and thinking. 

•	 cerebellum—Located at the lower rear of the 

brain, above the brain stem, the cerebellum 

controls balance, helps maintain equilibrium, 

and coordinates such complex muscle movements as walking and talking. 

The brain’s two halves, or hemispheres, use nerve 

cells (neurons) to speak with each other. Each side 

of the cerebrum controls movement and function 

on the other side of the body. In addition, each 

hemisphere has four sections, called lobes, which 

handle different neurological functions. 
 

Frontal Lobe Parietal Lobe 

controls planning, reasoning, processes sensations, 

and behavior coordinates complex 

motor tasks such 

as speech 

Temporal Lobe 

important for Occipital Lobe 

perception, memory, important for

and emotion vision and 

detecting motion

The frontal lobes 

manage voluntary 

movement, such as 

writing, and let us set

and prioritize goals. 

A frontal lobe tumor 

can cause changes in 

personality, intellect,

reasoning, and behav

ior; affect coordination and walking; and 

cause speech loss. The 

temporal lobes are 

linked to perception, 

memory, and understanding sounds and 

­

The brain’s two hemispheres have four sections 

each, called lobes, which handle different functions. 

The frontal lobes manage voluntary movement and 

reasoning. The temporal lobes are linked to perception, memory, and understanding sounds and words. 

The parietal lobes let us receive and understand 

sounds and words. The occipital lobes receive and 

process light and visual images, and detect motion. 

words. A tumor here might cause speech and hear

ing problems, blackouts, seizures, or sensations 

such as a feeling of fear. The parietal lobes let us 

simultaneously receive and understand sensations 

such as pressure and pain. A parietal lobe tumor 

might cause difficulty understanding or speaking 

words, problems with coordination, seizures, and 

numbness or weakness on one side of the body. The 

occipital lobes receive and process light and visual 

images, and detect motion. An occipital lobe tumor 

can affect the field of vision, usually on one side of 

the face, and how we understand written words. 

Three layers of protective tissue (called the meninges) cover the brain—the thick dura mater (outer), 

the arachnoid (middle), and the pia mater (inner

most to the brain). 

Brain tumors in infants and adults tend to be 

located in the cerebrum; brain tumors in children 

ages one to 12 years are more commonly found in 

the cerebellum. 

­

­

3 
4 

The spinal cord—an extension of the brain—lies 

protected inside the bony spinal column. It contains 

bundles of nerves that carry messages between the 

brain and other parts of the body, such as instructions from the brain to move an arm or information 

from the skin that signals pain. 

A tumor that forms on or near the spinal cord 

can disrupt communication between the brain 

and the nerves or restrict the cord’s supply of 

blood. Because the spinal column is narrow, a 

tumor here—unlike a brain tumor—can cause 

symptoms on both sides of the body at the same time. 

Most spinal cord tumors form below the neck. 

Symptoms generally strike body areas at the same 

level or at a level below that of the tumor. For 

example, a tumor midway along the spinal cord 

(in the thoracic spine) can cause pain that spreads 

over the chest and gets worse when the individual 

coughs, sneezes, or lies down. A tumor that grows 

in the cervical spine can cause pain that seems to 

come from the neck or arms, and a tumor that 

grows in the lower, lumbar spine can trigger 

back or leg pain. 

The three major groups of spinal cord tumor 

describe where they are found. Extradural tumors 

grow between the inner surface of the spinal canal 

and the tough dura mater. Tumors inside the dura 

(intradural tumors) are further divided into those 

outside the spinal cord (extramedullary tumors) 

and those inside the spinal cord (intramedullary 

tumors). Other descriptors for spinal cord tumors 

are intrinsic, meaning the tumor forms inside the 

spinal cord; and extrinsic, where the tumor forms 

outside of and presses on the cord as it grows. 
 

CNS Tumor FAQs 

What are benign and malignant tumors? 

No matter where they are located in the body, 

tumors are classified as benign or malignant. 

Benign tumors are slow growing, noncancerous 

cell masses that have a defined edge and do not 

spread to other parts of the body. Cells in the tumor 

are similar to normal cells. Often these tumors can 

be removed surgically and usually do not recur. 

Malignant, or cancerous, tumors have cells that 

look different from normal cells. They can quickly 

invade surrounding tissue and often have edges 

that are hard to define, which makes it difficult 

to remove the entire tumor surgically. 

What are primary and metastatic tumors? 

Primary tumors of the CNS are growths that 

begin in the brain or spinal cord. They can be 

either malignant or benign and are identified by 

the types of cells they contain, their location, or 

both. Most primary CNS tumors occur in adults. 

Metastatic, or secondary, tumors in the CNS are 

caused by cancer cells that break away from the 

primary tumor that first developed in a non-CNS 

part of the body. These tumors are named after the 

type of cancer that causes them. Metastastic tumors 

(also called metastases) in the CNS occur in about 

one-fourth of all cancers that develop in another 

part of the body, such as cancer of the lung, breast, 

or kidneys; or melanoma, a form of skin cancer. 

They are more common than primary tumors and 

occur more often in adults than in children. 

5 
 

 

 

6 

Metastatic spine 

tumors usually 

form within the 

bony covering of 

the spinal column 

but may also invade 

the spinal canal 

from the chest 

or abdomen. 

While cancers 

elsewhere in the 

body can easily 

cause tumors inside 

the brain and spinal 

cord, CNS tumors 

rarely spread outside 

the nervous system. The spinal cord lies protected inside the bony 

spinal column and contains bundles of nerves 

that carry messages between the brain and What causes 

other parts of the body. A tumor can press CNS tumors? on the spinal cord or nerve roots and cause 
 

symptoms that generally strike body areas 
 Researchers really at the same level or below that of the tumor. 

For example, a tumor in the cervical spine don’t know why 

can cause pain in the neck or arms, and a primary brain tumor in the lower, lumbar spine can trigger and spinal cord back or leg pain. 

tumors develop. 

Possible causes under investigation include viruses, 

defective genes, exposure to certain chemicals and 

other hazardous materials, and immune system 

disorders. Although smoking, alcohol consumption, 

and certain dietary habits are associated with 

some types of cancers, they have not been linked 

to primary CNS tumors. 
In a small number of individuals, CNS tumors 

may result from specific genetic diseases, such 

as neurofibromatosis and tuberous sclerosis, or 

exposure to radiation. Non-ionizing radiation 

(radio waves) from mobile phone use does not 

increase the risk of developing a brain tumor.2 

Brain and spinal cord tumors are not contagious 

or, at this time, preventable. 

Who is at risk? 

Anyone can develop a primary CNS tumor, 

although the risk is very small. Having one or 

more of the known risk factors does not guarantee 

that someone will develop a tumor. Brain tumors 

occur more often in males than in females and are 

most common in middle-aged to older persons. 

They also tend to occur more often in children 

under age 9 than in other children, and some 

tumors tend to run in families. Most brain 

tumors in children are primary tumors. 

Other risk factors for developing a primary 

CNS tumor include race (Caucasians are more 

likely to develop a CNS tumor than other races) 

and occupation. Workers in jobs that require 

repeated contact with ionizing radiation or certain 

chemicals, including those used to manufacture 

building supplies or plastics and textiles, have a 

greater chance of developing a brain tumor. 

2		Cellular Phone Use and Cancer Risk: Update of a Danish Nationwide 

Cohort. Schüz et. al., Journal of the National Cancer Institute, Vol. 98, 

No. 23, December 6, 2006, pp. 1703-1713. 

7 
8 

How many people have these tumors? 

More than 359,000 persons in the United States 

are estimated to be living with a diagnosis of 

primary brain or central nervous system tumor.3 

More than 195,000 Americans are diagnosed with 

a brain tumor each year.4

 Brain tumors are the 

most common form of solid tumor in children. 

Spinal cord tumors are less common than brain 

tumors. Although they affect people of all ages, 

spinal cord tumors are most common in young 

and middle-aged adults. Nearly 3,200 central 

nervous system tumors are diagnosed each year 

in children under age 20.5 

How are tumors graded? 

The generally accepted scale for grading CNS 

tumors was approved by the World Health 

Organization in 1993. Grading is based on the 

tumor’s cellular makeup and location. Tumors 

may also be classified as low-grade (slowly 

growing) or high-grade (rapidly growing). 

Some tumors change grades as they progress, 

usually to a higher grade, and can become a 

different type of tumor. The tumor is graded 

by a pathologist following a biopsy or 

during surgery. 

3 Central Brain Tumor Registry of the United States, 2005-2006 

4 American Brain Tumor Foundation 

5 Central Brain Tumor Registry of the United States, 2005-2006 
How Tumors Are Graded 

Grade I tumors Slow-growing tumors that generally do not spread 

to other parts of the brain. It is often possible to 

surgically remove an entire Grade I benign tumor, 

but this type of tumor may be monitored periodically, 

without further treatment. 

Grade II tumors Also grow slowly, sometimes into surrounding tissue, 

and can become a higher-grade tumor. Treatment 

varies according to tumor location and may require 

chemotherapy, radiation, or surgery followed by 

close observation. 

Grade III tumors Malignant tumors that can spread quickly into other 

CNS tissue. Tumor cells will look different than those 

in surrounding tissue. Aggressive treatment, often 

using a combination of chemotherapy, radiation, 

and/or surgery, is required. 

Grade IV tumors Malignant tumors that invade nearby tissue very 

quickly and are difficult to treat. The cancerous 

tissue will look very different from surrounding 

tissue. Aggressive treatment is required. 

What are the possible symptoms? 

Brain and spinal cord tumors cause many diverse 

symptoms, which can make detection tricky. 

Symptoms depend on tumor type, location, size, 

and rate of growth. Certain symptoms are quite 

specific because they result from damage to particular areas of the brain. Symptoms generally 

develop slowly and worsen as the tumor grows. 

The most obvious sign of a brain tumor in infants 

is a rapidly widening head or bulging crown. 

Common symptoms of a brain tumor in adults 

include headaches, seizures, problems with 

balance or coordination, loss of muscle control, 

hydrocephalus, and changes in personality 

or behavior. 

9 
10 

Headaches are the most common symptom of 

a brain tumor. Headaches may progressively 

worsen, become more frequent or constant, and 

recur, often at irregular intervals. Headache pain 

may worsen when coughing, changing posture, 

or straining and may be severe upon waking. 

Seizures can occur with symptoms that may 

include convulsions, loss of consciousness, or 

loss of bladder control. Seizures that first start 

in adulthood (in someone who has not been in 

an accident or who had an illness that causes 

seizures) are a key warning sign of brain tumors. 

Nausea and vomiting may be more severe in the 

morning and may accompany headaches. 

Vision or hearing problems can include blurred 

or double vision, partial or total loss of vision or 

hearing, ringing or buzzing sounds, and abnormal 

eye movements. 

Personality, behavior, and cognitive changes can 

include psychotic episodes and problems with 

speech, language, thinking, and memory. 

Motor problems can include weakness or paralysis, 

lack of coordination, or gradual loss of sensation 

or movement in an arm or leg. A sudden, marked 

change in handwriting may be a sign of a tumor. 

Balance problems can include dizziness, trouble 

with walking, clumsiness, or loss of the normal 

control of equilibrium. 

Hydrocephalus and increased intracranial pressure are caused when a tumor blocks the flow of 

the cerebrospinal fluid (CSF) that surrounds the 
brain and spinal cord. Symptoms may include 

headaches, nausea, and vomiting. 

Other symptoms may include endocrine disorders 

or abnormal hormonal regulation, difficulty swallowing, facial paralysis and sagging eyelids, fatigue, 

weakened sense of smell, or disrupted sleep and 

sleep pattern changes. 

Common symptoms of a spinal cord tumor include 

pain, numbness or sensory changes, motor problems, and loss of muscle control. 

Pain can feel as if it is coming from various parts 

of the body. Back pain may extend to the hips, 

legs, feet, and arms. This pain is often constant 

and may be severe. It is often progressive and 

can have a burning or aching quality. 

Numbness or sensory changes can include decreased 

skin sensitivity to temperature and progressive 

numbness or a loss of sensation, particularly in 

the legs. 

Motor problems and loss of muscle control can 

include muscle weakness, spasticity (in which the 

muscles stay stiffly contracted), and impaired 

bladder and/or bowel control. If left untreated, 

symptoms may worsen to include muscle wasting, 

decreased muscle strength, an abnormal walking 

rhythm known as ataxia, and paralysis. 

Symptoms may spread over various parts of 

the body when one or more tumors extend over 

several sections of the spinal cord. 

11 
 

How are CNS tumors diagnosed? 

A doctor, usually a neurologist, oncologist, or neurooncologist, can confirm a diagnosis of a brain or 

spinal cord tumor based on a patient’s symptoms, 

personal and family medical history, and results of 

a physical exam and specialized tests and techniques. 

A neurological exam—the first test—assesses 

movement and sensory skills, hearing and speech, 

reflexes, vision, coordination and balance, mental 

status, and changes in mood or behavior, among 

other abilities. Some tests require a specialist to 

perform and analyze results. 

Diagnostic imaging shows extremely detailed views 

of body structures, including tissues, organs, bones, 

and nerves. If there is a tumor, diagnostic imaging will 

confirm this diagnosis and help doctors determine 12 

the tumor’s type, detect swelling and 

other associated conditions, and, over 

time, check the results of treatment. 

See the NINDS publication, 

“Neurological Diagnostic Tests 

and Procedures,” for a more 

complete description of the 

following tests: http://www. 

ninds.nih.gov/disorders/misc/ 

diagnostic_tests.htm. 

Computed Tomography (CT) uses 

x-rays and a computer to produce 

fast, detailed cross-sectional images 

or “slices” of organs, bones, and 

tissues, including a tumor. It is also 

good for detecting the buildup of calcium, which causes tissue to harden 

and can develop into a tumor. 

Diagnostic imaging allows doctors 

to better determine the type of tumor, 

choose treatment options, and monitor 

treatment results. These MRI scans 

show a tumor (the dark area surrounded by a white ring) as seen from 

different angles and pinpoint its location 

in the left temporal lobe of the brain. 
 

 

 

Magnetic Resonance Imaging (MRI) uses a 

computer, radio waves, and a strong magnetic 

field to produce two-dimensional slices or a detailed 

three-dimensional model of tissue being scanned. 

MRI takes longer to perform than does a CT but 

is more sensitive and gives better pictures of 

tumors located near bone. 

Both CT and MRI scans for tumor are usually 

performed before and after administration of 

a “contrast agent” or dye has been given into 

a vein. Many tumors become much brighter on 

the scan taken after the contrast agent is given. 

Functional MRI (fMRI) creates images of areas of 

the brain with specific functions such as movement 

and language. It can assess brain damage from head 

injury or degenerative disorders, identify and monitor other neurological disorders such as stroke, 

and show the distance between specific brain functions and tumors in particular areas of the brain. 

Magnetic Resonance Spectroscopy (MRS) gives 

doctors a chemical snapshot of tissues being studied. 

It uses the MRI scanner’s magnetic field and radio 

waves to measure and analyze the chemical make-up 

of the tissue sample. 

Positron Emission Tomography (PET) provides 

computer-generated two- and three-dimensional 

scans of the brain’s chemical activity and cellular 

function. PET traces and measures glucose (used 

by the brain for energy) that is attached to small 

amounts of radioactivity and injected into the 

bloodstream. Since malignant tissue uses more 

glucose than normal tissue, it usually shows up 

on the scan as brighter than surrounding tissue. 

13 
 

 

14 

Single Photon Emission 

Computed Tomography 

(SPECT) studies blood 

flow to tissue. Certain 

tumors grow new blood 

vessels to increase their 

supply of blood and 

Diagnostic imaging can help doctors nutrients. A radioactive 

confirm a tumor diagnosis, determine the isotope is injected intra­ tumor’s type, detect swelling and other 

associated conditions, and, over time, venously and traced as 

check the results of treatment. One type it travels into the skull. 

of imaging, called positron emission A sophisticated computer tomography or PET (shown above), 

provides computer-generated two- and processes and stacks the 

three-dimensional scans of the brain’s data into a detailed three- chemical activity and cellular function. dimensional image of 

activity within the brain. 

Angiography (or arteriogram) can distinguish 

certain types of tumors that have a characteristic 

pattern of blood vessels and blood flow. A dye that 

deflects x-rays is injected into a major blood vessel 

and a series of x-rays is taken as the dye flows to 

the brain. In many situations angiography has 

been replaced by non-invasive tests such as CT 

and MRI. 

Testing blood, urine, and other substances can 

provide clues about the tumor and monitor levels 

of therapeutic drugs. 

Additional tests may include an electroencephalogram, or EEG, which monitors brain activity 

through the skull (tumors can disrupt the normal 

flow of brain wave activity and cause seizures); 

CSF analysis, in which a small amount of the 

cerebrospinal fluid is removed by a special needle 

and examined for abnormal cells or unusual levels 

of various compounds that suggest a brain or 
 

	 	 	 	 	 	 	

	 	 	 	 	 	 	

	 	 	 	 	

	 	 	 	 	 	

	 	 	 	 	 	 	

 

 

 

 

 

spinal cord tumor; and magnetoencephalography 

(MEG), which studies brain function by measuring 

the magnetic field generated by nerve cells in the 

brain. CSF fluid analysis should be performed 

with extreme caution on individuals with very 

large brain tumors. 

Diagnosing the distinct type of brain tumor is 

often difficult. Individuals should consider asking 

their primary care physician or oncologist for 

a second opinion, particularly from a neurooncologist or neurosurgeon, as there may be 

new information available and some tumors can 

change grade or recur. Even a second opinion that 

confirms the original diagnosis can help people 

better prepare for their care and treatment. 

How are brain and spinal cord tumors treated? 

A specialized team of doctors advises and assists 

individuals throughout treatment and rehabilitation. These doctors may include: 

•	 A neurologist is a specialist in nervous

system disorders. 

•	 A medical oncologist is a specialist in cancer.

•	 A neuro-oncologist is a neurologist who

specializes in nervous system tumors. 

•	 A neuroradiologist is a doctor trained in

reading diagnostic imaging results who 

specializes in the CNS. 

•	 A pathologist is a clinical physician who

diagnoses diseases of tissues or cells using 

a variety of laboratory tests. 

15 
	 	 	 	 	 	 	

	 	 	 	 	 	 	

 

 

 

 

16 

•	 A neurosurgeon is a brain or spinal cord surgeon.

•	 A radiation oncologist is a doctor who specializes in using radiation to treat individuals 

with cancer. 

This team will recommend a treatment plan based 

on the tumor’s location, type, size and aggressiveness, as well as on the individual’s medical history, 

age, and general health. 

Initial treatment for a CNS tumor may involve 

a variety of drugs, including anticonvulsants to 

treat seizures, pain medications, steroids or other 

anti-inflammatory drugs to reduce swelling and 

improve blood flow, antidepressants to treat anxiety or ease depression that might occur following a 

tumor diagnosis, and drugs to fight nausea caused 

by various treatments. 

Malignant tumors require some form of treatment, 

while some small benign tumors may only need 

periodic monitoring. The three standard treatment 

options for malignant CNS tumors are neurosurgery, 

radiation therapy, and chemotherapy. Some individuals may receive a combination 

“Each tumor is unique, of treatments. 

and the tumor type and Neurosurgery is usually the first

grade may change over step in treating an accessible 

time. There are several tumor—one that can be removed 

different treatment options without unacceptable risk of 

available, depending neurological damage. Surgery 

upon the type, size, and is aimed at removing all or as 

progression of the tumor.” much tumor as possible (called 

resecting or excising) and can 

slow worsening of neurological function. 

An inaccessible or inoperable tumor is one that 

cannot be removed surgically because of the risk of 

severe nervous system damage during the operation. 
 

 

 

 

These tumors are frequently located deep within the 

brain or near vital structures such as the brain stem. 

A biopsy is usually performed to help doctors determine how to treat a tumor. A brain biopsy involves 

surgically removing a small part of the skull to 

sample the tumor tissue. Biopsies can sometimes 

be performed by a needle inserted through a small 

hole. A small piece of tissue remains in the hollow 

needle when it is removed from the body. A pathologist will stain and examine the tissue for certain 

changes that signal the type of tumor and grade it 

to reflect the degree of malignancy. 

If the sample is cancerous, the surgeon will remove 

as much of the tumor as possible. For some primary 

brain tumors it is not possible to surgically remove 

all malignant cells. Malignant brain tumors commonly 

recur from cells that have spread from the original 

tumor mass into the surrounding brain tissue. Many 

benign tumors and secondary metastatic tumors 

can be completely removed surgically. 

In some cases, a surgeon may need to insert a shunt 

into the skull to drain any dangerous buildup of 

CSF caused by the tumor. A shunt is a flexible 

plastic tube that is used to divert the flow of CSF 

from the central nervous system to another part 

of the body where it can be absorbed as part of 

the normal circulatory process. 

Fortunately, research has led to advances in 

neurosurgery that make it possible for doctors 

to completely remove many tumors that were 

previously thought to be inoperable. These new 

techniques and tools let neurosurgeons operate 

within the tight, vulnerable confines of the CNS. 

Some tools used in the operating room include 

a surgical microscope, the endoscope (a small 

17 
 18 

Neurosurgery is usually the first step in treating an accessible tumor. The goals 

of surgery are to remove all or as much tumor as possible and slow worsening of 

neurological function. 

viewing tube attached to a video camera), and 

miniature precision instruments that allow surgery 

to be performed through a small incision in the 

brain or spine. 

Intraoperative MRI uses a special type of MRI 

to provide a real-time evaluation of the surgery. 

Constantly updated images during surgery let 

doctors see how much tumor material has been 

removed. Intraoperative MRI can also help 

doctors choose the best surgical approaches 

and monitor any complications during surgery. 

Navigation equipment used in computer-guided, 

or stereotactic, neurosurgery gives doctors a 

precise, three-dimensional map of an individual’s 

spine or brain as the operation progresses. A 

computer uses pre-operative diagnostic images 

of the individual to reduce the risk of damage 

to surrounding tissue. 
 

Intraoperative nerve monitoring tests such as 

evoked potentials use real-time recordings of 

nerve cell activity to determine the role of specific 

nerves and monitor brain activity as the surgery 

progresses. Small electrodes are used to stimulate 

a nerve and measure its electrical response (or 

evoked potential). Some surgeries may be done 

while the individual is awake under monitored 

anesthesia care, rather than under general 

anesthesia. This allows doctors to monitor the 

individual’s speech and motor functions as a 

tumor is being removed. 

A possible side effect of surgery is swelling around 

the site of the tumor, which can be treated with 

steroids. Bleeding into the tumor site or infection 

are other serious risks of brain surgery. 

In the case of a metastatic tumor, doctors usually 

treat the original cancer. However, if there are only 

one or two metastases to the brain or if a metastatic 

tumor causes serious disability or pain, doctors 

may recommend surgery—even if the original 

cancer has not been controlled. 

Surgery may be the beginning and end of your treatment if the biopsy shows a benign tumor. If the tumor 

is malignant, doctors often recommend additional 

treatment, including radiation and chemotherapy, 

or one of several experimental treatments. 

Radiation therapy usually involves repeated doses 

of x-rays or other forms of radiation to kill cancer 

cells or keep them from multiplying. When successful, this therapy shrinks the tumor mass but 

does not actually remove it. Radiation therapy can 

be used to treat surgically inaccessible tumors or 

tumor cells that may remain following surgery. 

19 
 

	 	 	 	 	 	 	

	 	 	 	 	 	

 

 

20 

Depending on tumor type and stage, radiation 

treatment might be delivered externally, using 

focused beams of energy or charged particles 

that are directed at the tumor, or internally, 

using a surgically implanted device. The stronger 

the radiation, the deeper it can penetrate to the 

target site. Healthy cells may also be damaged 

by radiation therapy but most are able to repair 

themselves, while the damaged tumor cells cannot. 

A radiation oncologist will explain the therapy 

and how much radiation is needed. Treatment 

often begins a week after surgery and may continue 

for several weeks. Depending on tumor type and 

location, individuals may be able to receive a 

modified form of therapy to lessen damage to 

healthy cells and improve the overall treatment. 

Externally-delivered radiation therapy poses no 

risk of radioactivity to the individual or family and 

friends. Types of external radiation therapy include: 

•	 Whole brain radiation is generally used to

shrink multiple cancerous tumors, rather 

than to target individual tumors. It may 

be given as the sole form of treatment or in 

advance of other forms of radiation therapy 

and microsurgery. Whole brain radiation is 

generally used for metastatic tumors and 

rarely for primary tumors. 

•	 Conventional external beam radiation aims a

uniform dose of high-energy radiation at the 

tumor and surrounding tissue from outside the 

body. It is used to treat large tumors or those 

that may have spread into surrounding tissue. 
	 	

	 	 	 	 	

	 	 	 	 	

	 	

 

 

 

 

•	 Three-dimensional conformal radiotherapy

(3D-CRT) uses diagnostic imaging to prepare an 

accurate, computer-generated three-dimensional 

image of the tumor and surrounding tissue. The 

computer then coordinates and sends multiple 

beams of radiation to the tumor’s exact shape, 

sparing nearby organs and surrounding tissue. 

•	 Intensity modulated radiation therapy (IMRT)

is similar to 3D-CRT but varies the intensity 

of the hundreds of individual radiation beams 

to deliver more precise doses to the tumor or 

to specific areas within it. IMRT can provide a 

highly effective dose of radiation to the tumor, 

with less exposure to surrounding tissue. 

•	 Hyperfractionation involves giving two or

more smaller amounts of radiation a day 

instead of a larger, single dose. It can deliver 

more radiation to certain tumors and reduce 

damage to normal cells. 

Radiosurgery is usually a one-time treatment 

involving a large amount of high intensity, sharply 

focused radiation that is aimed at the brain tumor. 

Stereotactic radiosurgery uses computer imaging 

to direct precisely focused radiation into the tumor 

from multiple angles. It does not actually cut into 

the person but, like other forms of radiation therapy, harms a tumor cell’s ability to grow and divide. 

Stereotactic radiosurgery is commonly used to treat 

surgically inaccessible tumors. It may also be used 

at the end of conventional radiation treatment. Two 

common stereotactic radiosurgery procedures are: 

•	 Linear-accelerated radiosurgery (LINAC)

uses radar-like technology to prepare and 

fire a single beam of high-energy x-rays into 

21 
 

22 

the tumor. Also called high linear-energy 

transfer radiation, LINAC forms the beam to 

match the tumor’s shape, avoiding surrounding 

tissue. A special machine that rotates around 

the head then fires a uniform dose of radiation 

into the tumor. 

•	 Gamma knife® radiosurgery focuses more 

than 200 beams of gamma radiation into one 

intersecting beam that is fired into the tumor. 

It also uses computer imaging to prepare a 

model of the tumor. This single treatment 

takes between one and four hours and is 

often recommended for inaccessible or hard 

to treat tumors. 

Both procedures may be given on an outpatient 

basis but an overnight stay in the hospital is 

often recommended. 

Proton beam therapy 

directs a beam of 

high-energy radiation into the tumor, 

leaving surrounding 

healthy tissue and 

organs intact. It is 

best used to treat 

tumors that are solid 

and have not spread 

to other parts of the 

body. Proton beam 

therapy can be used 

as a stand-alone 

treatment or in 

combination with 

chemotherapy or as 

follow-up to surgery. 

Radiation therapy can be used to treat surgically 

inaccessible tumors or tumor cells that may 

remain following surgery. Repeated doses of 

radiation can kill cancer cells or keep them 

from multiplying, and can be delivered 

externally or internally. 
 

 

Internal tumor radiation therapy, also called 

brachytherapy or interstitial radiation therapy, 

involves placing a small amount of radioactive 

material into or near the tumor (or its cavity, if 

the tumor has been surgically removed). In most 

cases, the radiation is inserted at the time of surgery 

or using imaging and a catheter. The radiation may 

be left in place for several days and, if more than 

one treatment is needed, the doctor may leave the 

catheter in place for a longer period. 

Individuals may need to be hospitalized for a few 

days following this procedure as the radiation may 

extend outside their body and could possibly harm 

others. The radiation becomes less active each 

day until it is safe for individuals who have been 

treated to be around others. 

Side effects of radiation therapy vary from person 

to person and are usually temporary. They typically 

begin about two weeks after treatment starts and 

may include fatigue, nausea, vomiting, reddened 

or sore skin in the area receiving treatment, headache, hearing loss, problems with sleep, and hair 

loss (although the hair usually grows back once 

the treatment has stopped). Radiation therapy 

in young children, particularly those children 

age three or younger, can cause problems with 

learning, processing information, thinking, and 

growing. Radiation therapy is painless. 

Chemotherapy uses powerful drugs to kill cancer 

cells or stop them from growing or dividing. These 

drugs are usually given by pill or injection and 

travel through the body to the brain, or can be 

inserted surgically using dissolvable wafers that 

have been soaked in a chemotherapeutic drug. 

These wafers slowly release a high concentrate 

of the drug to kill any remaining malignant cells. 

23 
24 

Chemotherapy may also be given to kill cancer cells 

in the spinal column. 

Chemotherapy is given in cycles to more effectively 

harm cancer cells and give normal cells time to 

recover from any damage. The oncologist will 

base the treatment on the type of cancer, drug(s) 

to be used, the frequency of administration, and 

the number of cycles needed. 

Individuals might receive chemotherapy to 

shrink the tumor (called neo-adjuvant therapy), 

in combination with radiation therapy, or after 

radiation treatment (called adjuvant therapy) to 

destroy any remaining cancer cells. Metronomic 

therapy involves giving continuous low-dose 

chemotherapy to block mechanisms that stimulate the growth of new blood vessels needed to 

feed the tumor. Chemotherapy is also used to 

treat CNS lymphoma (caused by cancer cells 

which form in the lymph system and are present 

in the CNS) and inaccessible tumors or tumors 

that do not respond to radiation therapy. 

Not all tumors are vulnerable to the same anticancer drugs, so a person’s treatment may include 

a combination of drugs. Common CNS chemotherapeutics include temozolomide, carmustine (also 

called BCNU), lomustine, tamoxifen, carboplatin, 

methotrexate, procarbazine, and vincristine. 

Side effects of chemotherapy may include hair loss, 

nausea, digestive problems, reduced bone marrow 

production, and fatigue. The treatment can also 

harm normal cells that are growing or dividing at 

the same time, but these cells usually recover and 

problems stop once the treatment has ended. 
 

Alternative and complementary approaches may 

help individuals better cope with their diagnosis 

and treatment. Some of these therapies, however, 

may be harmful if used during or after cancer 

treatment and should be discussed with a doctor 

beforehand. Common approaches include nutritional and herbal supplements, vitamins, special 

diet, and mental or physical techniques to 

reduce stress. 

What are the different CNS tumors and 

tumor-related conditions? 

There are many types of brain and spinal cord 

tumors. These tumors are named by their location 

in the body, cell of origin, rate of growth, and 

malignancy, if any. Some tumor types are more 

prevalent in children than in adults. Here is a 

listing of some common benign and malignant 

CNS tumors. 

Glioma tumors grow from several types of glial 

cells. Glial cells support the function of neurons. 

Gliomas usually occur in the brain’s cerebral 

hemispheres but may also strike other areas, 

especially the optic nerve, the brain stem and, 

particularly among children, the cerebellum. 

Gliomas are classified based on their type of 

glial cells. 

Astrocytomas include nearly half of all CNS tumors. 

They develop from star-shaped glial cells called 

astrocytes and can be benign or malignant. 

Astrocytomas tend to form in the cerebrum in 

adults and in most parts of the brain in children. 

25 
26 

These tumors occur most often in middle-aged men. 

The most common forms of astrocytoma are: 

•	 Anaplastic astrocytoma. Also called midgrade astrocytomas, these tumors grow 

rapidly and invade other tissue. Treatment 

includes surgery followed by radiation and, 

sometimes, chemotherapy. 

•	 Pilocytic astrocytoma. These slow-growing 

tumors occur most often in children and young 

adults and rarely spread into surrounding 

tissue. They usually have well-defined borders 

and may be removed entirely by surgery. 

•	 Glioblastoma multiforme. These malignant, 

highly invasive tumors spread quickly and 

often recur following initial treatment. Also 

called grade IV astrocytoma, these tumors 

are often found in adults between the ages 

of 45 and 70 years. Doctors usually treat 

glioblastomas with surgery followed by 

radiation therapy and chemotherapy. 

Ependymomas usually affect children and develop 

from cells that line the cavities of the brain and 

spinal canal where the CSF is made and stored. 

These tumors can also spread along the spinal 

canal. Most ependymomas are benign. Treatment 

usually includes surgery followed by radiation 

therapy. Chemotherapy is sometimes used, 

especially for recurrent tumors. 

Gangliogliomas are very rare, slow-growing, 

benign tumors that form from nerve cells and 

glial cells. They can occur in the brain and the 

spine. Gangliogliomas can often be removed 

entirely by surgery. Radiation therapy may 

be needed if the entire tumor cannot be resected. 
“There are more than Oligodendrogliomas, which 

120 types of brain and develop from glial cells within 

spinal cord tumors. the cerebral hemispheres 

Some are named by that help insulate the nerve 

their location, the type fibers that transmit nerve 

impulses, represent about of cell in which they 

5 percent of all gliomas. start, or rate of growth.” 

Oligodendrogliomas occur 

most often in men ages 40-70 but can be found in 

children. Treatment usually involves surgery followed by radiation therapy and chemotherapy for 

hard to reach tumors. 

Mixed gliomas contain more than one type of glial 

cell and are usually found in the cerebrum. They 

occur more frequently in adult men than women 

and can occur in children. These tumors can 

spread to other sites in the brain. Treatment 

focuses on the most malignant cell type found 

within the tumor. 

Other gliomas are named after the part of the 

body they affect. Among them are: 

Brain stem gliomas are found at the lowest part 

of the brain, which controls many vital body 

functions. They are most common in children 

and middle-aged adults. Surgery is not usually 

used to treat brain stem gliomas because of their 

vulnerable location. Radiation therapy sometimes 

helps to reduce symptoms and improve survival 

by slowing tumor growth. 

Optic gliomas are found on or near the nerves that 

travel between the eye and brain vision centers 

and are particularly common in individuals who 

have neurofibromatosis. These tumors usually 

occur in children and adolescents. Treatment 

includes surgery or radiation. 

27 
 

 

 

 

28 

Other childhood and adult 

CNS tumors include: 

Chordomas are rare congenital 

tumors which develop from 

remnants of the flexible spinelike structure that forms and Brain and spinal cord tumors are named by their 

location in the body, cell of origin, rate of growth, dissolves early in fetal develand malignancy. Gliomas grow from several opment (and is later replaced types of glial cells and usually occur in the by the bones of the spine). brain’s hemispheres but may also strike other 

areas, such as the optic nerve, the brain stem, Chordomas often occur near 

and the cerebellum. This photograph shows the top or the bottom of the glioma cells in green. spine, outside the dura mater, 

and can invade the spinal canal and skull cavity. 

Most often seen in persons in their 50s or 60s, 

chordomas are usually treated by a combination 

of surgery and radiation. 

Choroid plexus papillomas are rare, usually benign 

childhood tumors that develop slowly and can 

increase the production and block the flow of CSF, 

causing symptoms that include headaches and increased intracranial pressure. Treatment usually 

involves surgery to remove all or as much of the 

tumor as possible. A rarer cancerous form that can 

spread via the cerebrospinal fluid is typically treated 

with surgery, chemotherapy, and radiation therapy. 

Craniopharyngiomas, like chordomas, develop 

from cells left over from early fetal development. 

They often grow at the base of the brain, near the 

brain’s pituitary gland (which releases chemicals 

important for the body’s growth and metabolism), 

and may also affect the optic nerve and surrounding 

tissue. Craniopharyngiomas usually affect young 

children and adolescents. Treatment includes 

surgery and, in some people, radiation therapy. 
 

 

 

Dysembryoplastic Neuroepithelial Tumors 

(DNET) are benign, slow-growing tumors that are 

typically found in the top half of the brain. DNETs 

are seen most often in persons under age 20 but 

they can affect all ages. They are often diagnosed 

after a period of uncontrolled seizures, which can 

be treated surgically. 

Germ cell tumors may start in cells that fail to leave 

the CNS during development. These very rare childhood tumors usually form in the center of the brain, 

near the pineal gland, and can spread elsewhere 

in the brain and spinal cord. Different tumors 

are named after the type of germ cell and include 

teratomas (most common in newborns and infants), 

embryonic carcinomas, and germinomas. Depending on the tumor type, treatment involves radiation, 

chemotherapy, or a combination of therapies. 

Meningiomas are tumors that develop from the 

thin membranes, or meninges, that cover the brain 

and spinal cord. These benign tumors account for 

about 20 percent of all brain tumors and about 

25 percent of all primary spinal cord tumors. 

They affect people of all ages, but are most common among those in their 40s. Meningiomas usually 

grow slowly, generally do not invade surrounding 

normal tissue, and rarely spread to other parts 

of the CNS or body. Surgery is the preferred 

treatment for accessible meningiomas. 

Pineal Tumors account for about one percent 

of brain tumors. These tumors form in the pineal 

gland, a small structure located between the 

cerebellum and the cerebrum. When possible, 

physicians will begin treatment with surgery or 

perform a biopsy to confirm the tumor type. They 

may also recommend radiation or chemotherapy, 

29 
 

30 

or both, for malignant pineal tumors. The three 

most common types of pineal region tumors are 

gliomas, germ cell tumors, and pineal cell tumors. 

Pituitary Tumors (also called pituitary adenomas) 

are small tumors that form in the pituitary gland. 

This small gland releases hormones that influence 

the body’s growth, metabolism, and maturation. 

Most pituitary tumors are benign and their incidence increases with age. Pituitary tumors account 

for about 10 percent of all primary brain tumors. 

Doctors classify pituitary tumors into two groups— 

secreting and nonsecreting. Secreting tumors 

release unusually high levels of pituitary hormones, which can trigger neurological conditions 

and symptoms including hyperthyroidism and 

Cushing’s syndrome (the harmful over-production of the hormone cortisol). Treatment options 

include tumor resection, radiation therapy, and 

drug therapy. 

Primitive Neuroectodermal Tumors (PNETs) 

usually affect children and young adults. These 

malignant tumors may spring from primitive or 

immature cells left over from early development 

of the nervous system. PNETS can spread throughout the brain and spinal cord in a scattered, patchy 

pattern and, in rare cases, cause cancer outside 

the CNS. Doctors try to remove as much tumor as 

possible with surgery and follow up with radiation. 

Chemotherapy is used when the tumor affects the 

spinal canal or causes spinal cord compression. 

•	 Medulloblastomas, the most common PNET, 

represent more than 25 percent of all childhood 

brain tumors. They usually form in the cerebellum and can spread throughout the brain and 

along the spine. Most often these tumors are 

found in children under age 10. 
•	 Neuroblastomas account for up to 10 percent 

of childhood tumors. They generally appear 

above the adrenal glands but can be found in 

the brain and elsewhere in the body. Boys are 

slightly more at risk of developing these tumors 

than are girls. 

Schwannomas are benign tumors that arise from 

the cells that form a protective sheath around the 

body’s nerve fibers. They are usually benign and 

are surgically removed when possible. One of the 

more common forms of schwannoma affects the 

eighth cranial nerve, which contains nerve cells 

important for balance and hearing. Also known 

as vestibular schwannomas or acoustic neuromas, 

these tumors may grow on one or both sides of 

the brain. 

Vascular Tumors arise from the blood vessels of the 

brain and spinal cord. The most common of these 31 

rare, noncancerous tumors is the hemangioblastoma, 

which is linked in a small number of people to a 

genetic disorder called von Hippel-Lindau disease. 

Hemangioblastomas do 

not usually spread, and 

doctors typically treat 

them with surgery. 

Tumor-related conditions 

CNS lymphoma occurs 

when cancerous cells 

which form in the lymph 

system (a part of the 

body’s immune system) 

are present in the CNS. 

Primary CNS lymphoma 

begins in the brain; it 

affects a small number 

Spinal cord tumors can disrupt communication 

between the brain and the nerves or restrict the 

cord’s blood supply. Because the spinal column 

is narrow, a tumor here (illustrated above) can 

cause symptoms on both sides of the body at 

the same time. The illustration below shows a 

cross section of the spinal cord and tumor. 
 

 

 

 

 

 

 

32 

of otherwise healthy people and a larger fraction 

of those who have an impaired immune system, 

whether from organ transplants, infection with 

the AIDS virus, or other causes. Secondary 

brain lymphoma occurs when tumor cells from a 

lymphoma located outside the brain metastasize to 

the CNS. Doctors usually treat the disorder with 

chemotherapy or radiation. When the linings of the 

spinal canal are affected, chemotherapeutic drugs 

are either injected into the CSF either through 

a lumbar puncture needle or special equipment 

placed under the scalp that is connected to a tube 

that enters the normal CSF spaces (ventricles) 

within the brain. 

Arachnoid cysts are benign, fluid-filled masses that 

form within a thin membrane lining (tumors are solid 

tissue masses). Cysts in the CNS can cause tumorlike symptoms, including headache and seizures. 

Some cysts occur more often in the spinal cord 

than in the brain, and certain cysts are seen most 

frequently in children. Depending on their size 

and location, cysts may be monitored periodically 

for any change or treated surgically. 

Hydrocephalus involves the buildup of cerebrospinal fluid in the brain. The excessive fluid can 

cause harmful pressure, headaches, and nausea. 

Treatment includes surgical insertion of a shunt 

that drains excess fluid to another area of the body, 

where it is absorbed as part of the circulatory 

process, or surgical treatment without a shunt 

to restore CSF circulation. 

Meningeal carcinomatosis is caused by cancer cells 

that metastasize to the CNS and spread around the 

brain and spinal cord via the cerebrospinal fluid. 
 

 

 

 

 

 

 

 

These cells can form colonies or small tumors in many 

places, including the roots of nerves, the surface of 

the brain, the cerebrum, the brain stem, and the 

spinal cord. Treatments include radiation, which can 

sometimes slow growth of the cells, and chemotherapy. 

Neurofibromatosis refers to related genetic disorders 

that cause tumors to grow around nerves. Most 

tumors are benign but can become malignant over 

time. The more common form of this disorder, 

neurofibromatosis type 1, usually causes tumors 

in nerves outside the CNS and affects the skin and 

bones. Neurofibromatosis type 2 causes multiple 

CNS tumors that typically affect the nerve involved 

with hearing. Treatment may include surgery and 

radiation therapy. 

Pseudotumor cerebri, also called “false brain 

tumor,” mimics brain tumor symptoms and may be 

caused by the abnormal buildup of cerebrospinal 

fluid. It is diagnosed by ruling out all other possible 

causes for symptoms and confirming that the cerebrospinal fluid pressure is increased. Pseudotumor 

cerebri is most common in women ages 20 to 50 years 

and can cause progressive visual loss in some individuals if left alone. Treatment may include drugs to 

relieve pressure and shunting to drain the fluid to 

another area of the body. 

Tuberous sclerosis is a genetic disorder that causes 

such numerous neurological and physical symptoms 

as seizures and benign tumors of the eyes and CNS. 

It may be present at birth or develop over time. 

About half of people who have tuberous sclerosis 

develop benign astrocytomas. Treatment may 

include drug therapy and regular monitoring 

by a doctor. 

33 
 

 

 

34 

von Hippel-Lindau disease is a rare genetic multisystem disorder characterized by tumors that grow 

in certain parts of the body. Slow-growing benign 

tumors called hemangioblastomas (cyst-like masses 

of tangled blood vessels) may develop in the brain 

and nervous system. Treatment usually involves 

surgical resection of the tumor. 

What is the prognosis? 

Each person is different. Prognosis depends greatly 

on prompt diagnosis and treatment, the individual’s 

age and general health, whether the tumor is malignant or benign, tumor size and location, tumor 

grade, and response to therapy. An individual 

whose entire tumor has been removed successfully 

may recover completely. Generally, prognosis is 

poorer in very young children and in older individuals. Rehabilitation and counseling can help 

individuals and family members better cope with 

the disorder and improve quality of life. 

Continued monitoring and long-term follow-up 

is advised as many tumors resist treatment and 

tend to recur. 

Normal tissue and nerves that may have been 

damaged or traumatized by the tumor or its treatment will need time to heal. Some post-treatment 

symptoms will disappear over time. Physical therapy 

can help people regain motor skills, muscle strength, 

and balance. Some individuals may need to relearn 

how to swallow or speak if the brain’s cognitive areas 

have been affected. Occupational therapy can teach 

people new ways to perform tasks. Supportive care can 

help people manage any pain and other symptoms. 
 

 

 

 

What research is being done? 

Scientists continue to investigate ways to better 

understand, diagnose, and treat CNS tumors. 

Several of today’s treatment regimens were experimental therapies only a decade ago. Current clinical studies of genetic risk factors, environmental 

causes, and molecular mechanisms of cancers may 

translate into tomorrow’s treatment of, or perhaps 

cure for, these tumors. 

Much of this work is supported by the National 

Institutes of Health (NIH), through the collaborative 

efforts of its National Institute of Neurological 

Disorders and Stroke (NINDS) and National Cancer 

Institute (NCI), as well as other agencies within the 

Federal government, nonprofit groups, pharmaceutical companies, and private institutions. Some of 

this research is conducted through the collaborative neuroscience and cancer research community 

at the NIH or through research grants to academic 

centers throughout the United States. 

The jointly sponsored 


NCI-NINDS Neuro-


Oncology Branch coordi­


nates research to develop 


and test the effectiveness 


and safety of novel 


therapies for people 


with CNS tumors. These 


experimental treatment 
 Scientists are developing and testing the

options may include 	 effectiveness and safety of novel therapies for 

new drugs, combination people with CNS tumors. These experimental 

treatment options may include new drugs, therapy, gene therapy, combination therapy, gene therapy, biologic 

biologic immuno-agents, 	 immuno-agents, surgery, and radiation. Much 

of this work is supported by the National surgery, and radiation. Institutes of Health (NIH). 

35 
36 

Information about these trials, and trials 

involving other disorders, can be accessed at 

the Federal government’s database of clinical 

trials, http://clinicaltrials.gov. 

Part of this research involves creating a comprehensive public database of clinical, molecular, 

and genetic information on brain tumors to help 

researchers and clinicians identify and evaluate 

molecular targets in brain cancer. The joint 

NCI-NINDS Repository for Molecular Brain Neoplasia Data (REMBRANDT) will hold genetic and 

molecular analyses of samples from participants 

in NCI-sponsored clinical trials in what is slated 

to become the largest clinical/genetic corollary 

study ever conducted on brain tumors. It will 

also store a wide array of molecular and genetic 

data regarding all types of brain tumors. Understanding the biology behind these tumors will 

provide clues to new therapeutic approaches. 

Researchers are also developing mouse models 

that mimic human CNS cancers, which may speed 

discovery of potential treatments in humans. 

Beyond these efforts to develop needed resources, 

scientists at the NIH and at universities across 

the US are exploring a variety of approaches to 

treat developing CNS tumors. These experimental 

approaches include boosting the immune system 

to better fight tumor cells, therapies that target 

the tumor cell while sparing normal cells, making 

improvements in radiation therapy, disabling the 

tumor using genes attached to viruses, and defining 

biomarkers that may predict the response of a CNS 

tumor to a particular treatment. 
 

 

“Scientists continue to 

investigate new ways to

Biological therapy better understand, diagnose, involves enhancing the and treat central nervous 

body’s overall immune system tumors. Several of response to recognize today’s treatments were and fight cancer cells. experimental therapies The immune system only a decade ago.” is designed to attack 

foreign substances 

in the body; since cancer cells aren’t foreign, 

they usually do not generate much of an immune 

response. Researchers are using different methods 

to provoke a strong immune response to tumor 

cells. Such proteins as interleukin and interferon 

(both of which are part of a group of immune 

system “messengers” called cytokines) and other 

substances can stimulate and restore the body’s 

natural response against proteins on the surface 

of cancer cells and thus slow tumor growth. Other 

therapy uses viruses, T cells (a major component 

of immune system function), and other substances 

to increase immune response and target the tumor 

cells. Scientists are also experimenting with genetically altered T cells from the person’s own body, 

which are cultured with an antigen and injected 

directly into the brain following surgery. Biological 

therapies to fight CNS tumors include vaccines, gene 

therapy, antibody therapy, and tumor growth factors. 

Antibodies are proteins that are normally produced 

by the body to ward off bacteria and viruses. 

Monoclonal antibodies are multiple copies of a 

single antibody that act as a homing device to fit 

one—and only one—type of antigen (a protein 

on the surface of the tumor cell that stimulates 

the immune system response). Scientists at the 

NINDS and elsewhere are linking these antibodies 

37 
38 

to immunotoxins that seek out tumor cells with 

a matching antigen, bind to these tumor cells, 

and deliver their toxin, with minimal damage to 

surrounding normal cells. Additional approaches 

include attaching a radioactive substance to the 

antibodies, which act as targeting agents to deliver 

radiation to the tumor cell. 

Gene therapy (also called gene transfer) aims to 

deliver a suicide gene to the tumor cell or to boost 

the immune system. A gene whose activity can 

be influenced to kill the cell is integrated into a 

virus that can cross the blood-brain barrier (an 

elaborate network of fine blood vessels and cells 

that filters the blood reaching the CNS) and travel 

to the tumor. Delivery methods under investigation 

include viruses and stem cells. Gene therapy may 

become an important add-on therapy for individuals who do not respond well to other treatments. 

Scientists are testing the effectiveness of vaccine 

therapy for a variety of CNS tumors. Vaccine 

therapy strengthens the immune response by 

inserting an antigen that the body will attack. 

Some vaccines target a specific antigen, while 

others, using the whole tumor cell to make the 

vaccine, hope to target multiple antigens which 

the tumor may express. Research has shown the 

vaccine can be genetically engineered with tumor 

antigens and injected into the body to induce an 

immune response, which increases the attack on 

antigens expressed on the surface of the tumor 

cell. Experimental CNS tumor vaccines include 

those designed to stimulate an immune response 

to a particular protein or antigen, and dendritic 

cell vaccines (in which blood cells are taken from 

the body, processed in a laboratory and given 
 

 

back to the body to break up the tumor cell outer 

protein into smaller pieces, which increases 

targeting by immune cells). 

Findings from NIH-sponsored research on adult 

CNS tumor development and treatment suggest 

the immune system and, potentially, infection 

with the cytomegalovirus may play a critical role in 

certain tumor-type risk and prognosis. Repeated 

stimulation of the immune system to counter this 

herpes virus may serve as a tumor promotion 

factor. Scientists hope to identify immune factors and develop targeted immunotherapies 

for this disease. 

Targeted therapy offers great promise for treating cancerous cells without destroying other cells. 

Targeted therapy uses different molecules to reduce 

tumor gene activity and suppress uncontrolled 

growth by killing or reducing the production of 

tumor cells. Of particular interest to scientists 

is the development of tailored therapeutics— 

involving a combination of targeted agents— 

to treat tumors based on their genetic makeup. 

Specifically, molecularly targeted drugs seek out 

the molecular and cellular changes that convert 

normal cells into cancer. Many targeted cancer 

therapies are being tested in animals for use alone 

or in combination with other cancer treatments, 

such as chemotherapy. Researchers also hope 

to discover tumor-specific cellular or molecular 

pathways that can be used to increase drug delivery 

and to find ways to identify people who may benefit 

from combined therapy. Targeted therapies include 

growth factors, anti-angiogenetics, antisense technology, and small molecules aimed at blocking 

gene activity. 

39 
40 

Scientists are using a new genetically engineered mouse strain to study the role 

of the neurofibromatosis type 1 (NF1) gene in brain development. NF1 is a genetic 

disorder that causes brain and nerve tumors as well as learning disabilities. Brain 

neurons lacking NF1 gene expression (in red) are shorter than normal. The green 

color shows a protein and the blue is a counterstain. 

Growth factors often govern normal cell growth. 

Growth factors are released from either the cell 

or the surrounding tissue. Cancer cells can 

either secrete these growth factors or respond 

to them, enabling them to divide out of control. 

A number of tumor growth factors have been 

identified, including those that trigger nerve 

tissue growth and stimulate blood vessels to grow 

(a process called angiogenesis). Researchers 

continue to identify and develop agents that 

can block these factors. 
 

 

 

 

 

Oncogenes are transformed genes that are involved 

in cell growth and cause normal cells to divide 

uncontrolled and become malignant, either through 

mutation or over-production. Researchers have 

identified specific events that lead to this mutation 

and are developing diagnostic and therapeutic 

screening tools. 

Anti-angiogenetics—compounds that block blood 

vessel growth and the flow of nutrients and oxygen 

to the tumor—are proving to be a promising therapy for brain tumors. These compounds also may 

hamper cell signaling and stop tumor cells from 

spreading elsewhere in the body. Clinical trials 

have shown that anti-angiogenetics can improve the 

outcome for glioblastoma multiforme tumors that 

recur following initial treatment with radiation and 

chemotherapy. More than a dozen such compounds 

have been identified, including bevacizumab, interferon, and endostatin. Researchers are studying the 

combination of anti-angiogenics and radiation or 

chemotherapy in treating newly diagnosed brain 

tumors. Other research is testing angiogenic inhibitors that have had positive results in adults on 

children with primary CNS tumors and in individuals with tumors that have not responded well to 

other tumor treatment. 

Certain enzymes that are involved in cell division 

or the copying of genetic information may be overproduced in cancer cells, causing gene mutations 

and uncontrolled cell growth. Several different 

types of kinase inhibitors—proteins that block 

growth-signaling enzymes without harming normal 

cells—have been identified and approved for cancer 

treatment. Scientists are testing protein-level kinase 

inhibitors to see of they make CNS tumors more 

41 
 

 

42 

sensitive to chemotherapy. Clinical trials for brain 

tumors are studying the safety and effectiveness 

of kinase inhibitors in children with CNS tumors 

and in other individuals with recurring or hard to 

treat tumors. 

Antisense oligonucleotide technology uses short 

fragments of nucleic acid molecules to block gene 

expression in specific cells and prevent tumor growth. 

Unlike gene therapy, antisense oligonucleotide 

technology does not replace or substitute genetic 

material but inhibits the expression of select 

targets. This technology (also known as RNA 

interference, siRNA, or shRNA) may help 

scientists to identify additional genes involved in 

tumor formation and improve drug delivery with 

fewer side effects. 

Also of particular interest are microRNAs (or 

miRNAs)—naturally occurring molecules that 

regulate gene activity and are involved in the 

formation and development of tumor stem cells. 

Scientists are using miRNAs to switch off tumor 

stem cell activity. Researchers are studying miRNAs 

as a possible diagnostic and therapeutic strategy 

for brain tumors and other forms of cancer. 

Biomarkers are molecules or others substances 

in the blood or tissue that can be used to diagnose 

or monitor a particular disorder, among other 

functions. As cells become cancerous, they can 

release unique proteins and other molecules into 

the body which scientists use to speed diagnosis 

and treatment. Some CNS tumor biomarkers have 

been found, such as the epithelial growth factor 

receptor (EGRF) gene. Researchers continue to 
 

 

 

search for additional clinical biomarkers of CNS 

tumors, to better assess risk from environmental 

toxins and other possible causes, and monitor 

and predict the outcome of CNS tumor treatment. 

NINDS-funded research has recently shown that 

mutation analysis of EGFR can be used to predict 

which tumors are most likely to respond to a specific class of cancer-fighting drugs. Identifying 

biomarkers may also lead to the development 

of new models of disease and novel therapies 

for tumor treatment. 

Radiation therapy research includes testing several 

new anticancer drugs, either independently or in 

combination with other drugs, to improve treatment 

delivery and effectiveness. Researchers are also 

testing different drugs in combination with other 

therapies and are investigating combined therapies 

such as radiation and radiosurgery to effectively 

treat CNS tumors. Research areas being explored 

include tomotherapy, boron neutron capture 

therapy, liquid radiation therapy, and the use 

of radiosensitizers. 

Radiosensitizers are drugs that make rapidly 

dividing tumor tissue more vulnerable to radiation. 

Early studies using radiosensitizers produced mixed 

results. While some trials suggested these drugs may 

improve survival in certain individuals, other trials 

showed little benefit. Scientists are now testing an 

experimental drug that increases the amount of 

oxygen that is released from the blood into the tissues, 

making cancer cells more responsive to radiation 

and chemotherapy. Studies show the lack of oxygen 

in a tumor can make radiation therapy less effective. 

43 
 

 

44 

Many new approaches to treating CNS tumors 

Tomotherapy combines CT scanning and intensity 

modulated radiation therapy to deliver small beams 

of high-dose radiation to the tumor while greatly 

reducing radiation exposure to surrounding tissue. 

Studies are examining the effectiveness of radiation delivery through tomotherapy and to see if 

long-term side effects of radiation therapy can 

be reduced. 

Boron Neutron Capture Therapy (BNCT) is an 

experimental treatment that uses fission to kill 

tumor cells. An amino acid or other drug that 

carries boron is injected into the body, where it 

collects more readily in tumor cells than in regular 

tissue. A beam of low-energy neutrons is directed at 

the tumor from outside the body, causing the boron 

atoms to split (called neutron capture) and send 

high amounts of energy into the cancerous cells. 

Radiation damage to surrounding cells is extremely 

small. BNCT is being tested 

as a post-surgery treatment 

for people with certain head 

and neck tumors. If successful, BNCT could someday 

be used to treat children 

with brain tumors. 

Liquid radiation therapy is 

an experimental treatment 

that uses a balloon catheter 

to deliver internal radiation 

therapy to the cavity that 

remains following tumor 

surgery. A radioactive liquid 

is injected into the catheter 

and molds the balloon to the appear promising and new clinical trial designs are 

being developed to more quickly evaluate novel exact edges of the cavity. The 

agents. Past research has led to improved tumor 

treatments and techniques for many individuals 

with CNS tumors. In the years ahead, we can look 

forward to new, more effective forms of therapy. 
liquid stays in the balloon for several days until it 

and the catheter are removed. 

Chemotherapeutic drug research focuses on ways 

to better deliver the drugs across the blood-brain 

barrier and into the site of the tumor. Since chemotherapeutic drugs work in different ways to stop 

tumor cells from dividing, several trials are testing 

whether giving more than one drug, and perhaps 

giving them in different ways (such as staggered 

delivery and low-dose, long-term treatment), may 

kill more tumor cells without causing or lessening damaging side effects than present therapy. 

Researchers are examining different levels of 

chemotherapeutic drugs to determine if they are 

less toxic to normal tissue when combined with 

other cancer treatments. Other studies are investigating gene therapy as a way to make cancer 

cells more sensitive to chemotherapy. Research 

areas include differentiating drugs, osmotic 

blood-brain barrier disruption, and convection 

enhanced delivery. 

Differentiating drugs change dividing cells into 

nondividing cells and can halt tumor growth. An 

early study using retinoids (made from vitamin A) 

as an independent treatment for certain tumors 

showed no significant effect. Scientists are trying 

retinoids in combination with other chemotherapeutic drugs or treatments to slow the growth of 

malignant glioma. 

Researchers are testing different drugs and molecules to see if they can modulate the normal activity 

of the blood-brain barrier and better target tumor 

cells and associated blood vessels. 

45 
 

 

46 

Osmotic blood-brain barrier disruption uses 

certain drugs to open blood vessels throughout 

the brain. Scientists are currently studying 

whether certain chemotherapeutic drugs, when 

given with osmotic blood-brain barrier disruption, 

might be an effective way to kill cancer cells 

without harmful side effects. 

Convection enhanced delivery sends a continuous, 

uniform stream of toxic drugs into the tumor via 

catheters that are inserted during surgery. This 

drug delivery system, which bypasses the bloodbrain barrier, is being evaluated in children with 

recurring brain cancer and in individuals whose 

tumor location prevents its total surgical removal. 

Also under investigation are ways to help the body 

respond to improved drug delivery or other cancer 

treatments. Bone marrow and stem cell transplants 

may replace blood-forming cells that are killed by 

chemotherapy, radiation treatment, or a combination of therapies. These transplants, which are 

given after radiation or chemotherapy, help the 

bone marrow recover and produce healthy blood 

cells. Researchers are studying the effectiveness 

of these transplants in protecting blood cells in 

children with certain types of CNS tumors and in 

other individuals with recurrent or hard to treat 

CNS cancer, who receive higher than normal 

doses of chemotherapy. 

Although many new approaches to treatment 

appear promising, it is important to remember 

that all potential therapies must stand the tests 
of well-designed, carefully controlled clinical 

trials and long-term follow-up of participants 

before any conclusions can be drawn about their 

safety or effectiveness. New trial designs are 

also being developed to more quickly evaluate 

novel agents and may involve pre-selection of 

participants based on the molecular abnormality 

in their tumor. 

Past research has led to improved tumor treatments and techniques for many individuals with 

CNS tumors. Current research promises to generate further improvements. In the years ahead, 

physicians and individuals who have a CNS tumor 

can look forward to new, more effective, less toxic 

forms of therapy developed through a better 

molecular understanding of the unique traits 

of CNS tumors. 

Where can I get more information? 

For more information about brain and spinal 

cord tumors, other neurological disorders, or the 

National Institute of Neurological Disorders and 

Stroke, contact the Institute’s Brain Resources 

and Information Network (BRAIN) at: 

BRAIN 

P.O. Box 5801
 


Bethesda, MD 20824



(800) 352-9424 

www.ninds.nih.gov 

47 
48 

Also contact the National Cancer Institute for 

information about brain and spinal cord tumors 

and other cancers: 

National Cancer Institute 

National Institutes of Health, DHHS 

6116 Executive Boulevard 

Suite 3036A, MSC 8322 

Bethesda, MD 20892-8322 

(800) 4-CANCER (422-6237) or (800) 332-8615 (TTY) 

www.cancer.gov 

Private voluntary organizations that provide 

information on research, treatment, diagnosis, 

and other services regarding CNS tumors and 

tumor-related conditions include: 

Accelerate Brain Cancer Cures, Inc. (ABC2) 

1717 Rhode Island Avenue, NW 

Suite 700 

Washington, DC 20036 

(202) 419-3140 

www.abc2.org 

American Brain Tumor Association 

2720 River Road 

Suite 146 

Des Plaines, IL 60018 

(847) 827-9910 

(800) 886-2282 

www.abta.org 

American Cancer Society 

National Home Office 

1599 Clifton Road, NE 

Atlanta, GA 30329-4251 

(800) ACS-2345 or TTY (866) 228-4327 

www.cancer.org 
Brain Tumor Society 

124 Watertown Street 

Suite 311 

Watertown, MA 02472-2500 

(617) 924-9997 

(800) 770-8287 

www.tbts.org 

Childhood Brain Tumor Foundation 

20312 Watkins Meadow Drive 

Germantown, MD 20876 

(301) 515-2900 

(877) 217-4166 

www.childhoodbraintumor.org 

Children’s Brain Tumor Foundation 

274 Madison Avenue 

Suite 1004 

New York City, NY 10016 

(212) 448-9494 

(866) 228-4673 

www.cbtf.org 

Cushing’s Support and Research Foundation 

65 East India Row 

Suite 22B 

Boston, MA 02110-3389 

(617) 723-3674 

http://csrf.net 

International RadioSurgery Association 

3002 North Second Street 

Harrisburg, PA 17110 

(717) 260-9808 

www.irsa.org 

49 
50 

Katie’s Kids for the Cure/National Fund for 

Pediatric Brain Tumor Research 

3741 Walnut Street 

Box 612 

Philadelphia, PA 19104 

(610) 831-9026 

(877) 587-5437 

www.katieskids.org 

Musella Foundation for Brain Tumor Research 

and Information 

1100 Peninsula Boulevard 

Hewlett, NY 11557 

(516) 295-4740 

(888) 295-4740 

www.virtualtrials.com 

National Brain Tumor Foundation 

22 Battery Street 

Suite 612 

San Francisco, CA 94111-5520 

(415) 834-9970 

(800) 934-2873 

www.braintumor.org 

North American Brain Tumor Coalition 

www.nabraintumor.org 

Pediatric Brain Tumor Foundation 

302 Ridgefield Court 

Asheville, NC 28806 

(828) 665-6891 

(800) 253-6530 

www.pbtfus.org 
Pituitary Network Association 

P.O. Box 1958
 

Thousand Oaks, CA 91358


(805) 499-9973
 

www.pituitary.org 

The Preuss Foundation, Inc.


2232 Avenida de la Playa
 

Suite 220


La Jolla, CA 92037


(858) 454-0200
 

51 
52 

Glossary 

accessible tumor—a tumor that can be reached 

and removed using surgical tools without 

unreasonable risk of severe damage. 

angiogenesis—blood vessel formation. Certain 

tumors promote blood vessel formation in 

surrounding tissue. 

angiography—an imaging technique that 

provides an X-ray picture of blood vessels. 

anti-angiogenetics—compounds that block 

blood vessel growth and the flow of nutrients 

and oxygen to a tumor. 

antigen—a protein on the surface of a cell that 

stimulates the immune system. 

antineoplaston—a naturally occurring substance 

isolated from normal human blood and urine 

that is being tested as a type of treatment for 

some tumors. 

antisense oligonucleotide technology—also 

known as RNA interference. Uses short fragments 

of nucleic acid molecules to block gene expression 

in specific cells and prevent tumor growth. 

apoptosis—cell death triggered by molecular 

steps in the cell. 

astrocytoma—a tumor found mostly in the brain 

that is made up of star-shaped nerve support cells 

called astrocytes. 
benign—nonmalignant or noncancerous. Often 

used to describe tumor cells that are similar to 

other normal cells, grow relatively slowly, and 

are confined to one location. 

biopsy—a diagnostic test in which a sample of a 

patient’s cells or tissue is removed and examined 

for disease. 

blood-brain barrier—a complex, natural, 

protective network of fine blood vessels and 

cells that filters blood and prevents most drugs 

and molecules from traveling through the 

blood stream and into the brain. 

boron nuclear capture technology—a form 

of radiation therapy which uses boron to kill 

the tumor cells without harming normal cells. 

brain stem—the lowest part of the brain, 

connected to the spinal cord. It controls basic 

life functions, including breathing, heart beat, 

and blood pressure. 

brain stem glioma—a tumor found in the lowest 

part of the brain that begins in glial cells, which 

support other brain function. 

central nervous system (CNS)—the brain and 

spinal cord. 

cerebrospinal fluid (CSF)—the clear liquid 

that bathes the brain and spinal cord. 

cerebellum—located at the lower rear of the 

head, above the brain stem, it controls balance, 

helps maintain equilibrium, and coordinates 

complex muscle movements like walking 

and talking. 

53 
54 

cerebrum—the tissue that forms the bulk of the 

brain and is divided into broad regions, called 

lobes, that control different functions. 

chemotherapy—treatment with drugs designed 

to kill cancer cells. 

choroid plexus papilloma—a rare, usually 

benign, tumor that develops in an area of the 

brain that produces cerebrospinal fluid. 

chordoma—a rare congenital tumor formed by 

remnants of the fetal structure that is replaced 

by the spine. 

computed tomography (CT)—an imaging technique that uses X-rays and computer analysis to 

create a picture of body tissues and structures. 

congenital tumor—an abnormal growth present 

at birth. 

convection enhanced delivery—a drug delivery 

system in which a continuous stream of toxic 

drugs is sent to the tumor via catheters that 

are inserted following surgery. 

craniopharyngioma—a tumor that develops 

from cells left over from early fetal development. 

cyst—a noncancerous fluid-filled mass that 

forms within a thin membrane. 

cytokines—messenger proteins that can strengthen 

or suppress immune system activity. 

differentiating drugs—drugs that change cancer 

cells so they divide less often. 
 

dura mater—a tough, fibrous, two-layered 

membrane covering the brain and spinal cord. 

The dura mater is located inside the spinal 

bones and skull and is the outermost layer 

of the meninges. 

electroencephalogram (EEG)—a written 

recording of the brain’s electrical activity. 

ependymoma—a tumor that begins in cells 

that line the spinal cord and the cavities of 

the brain where cerebrospinal fluid is made 

and stored. 

frontal lobe—a part of the brain that directs 

voluntary muscle movement and goal setting. 

ganglioglioma—a very rare, nonaggressive, 

benign brain or spinal tumor that forms from 

nerve cells and glial cells. 

gene therapy—treatment that inserts a new 

gene into the tumor cell, which causes tumor 

cell suicide. 

germ cell tumor—a rare childhood tumor that 

may start in cells that fail to leave the central 

nervous system during development. 

glial cell—a type of cell that supports and 

surrounds nerve cells. 

glioblastoma—an often fast-growing tumor formed 

from star-shaped glial cells called astrocytes. 

glioma—a tumor that begins in glial cells, which 

support other brain function. 

55 
56 

grading—a scale used to assess a tumor’s cellular 

makeup (abnormality of cancer cells as compared 

to normal cells) and location. Doctors use tumor 

grading and other factors to develop a patient’s 

treatment plan. 

growth factors—substances that regulate normal 

cell growth and division. 

hydrocephalus—abnormal accumulation of 

cerebrospinal fluid within the brain. 

immunotherapy—treatment that boosts the 

ability of the body’s immune system to fight 

cancer and illnesses. 

inaccessible or inoperable tumor—a tumor that 

cannot be reached surgically without unreasonable 

risk of severe damage to nearby tissue. 

kinase inhibitors—proteins that block growthsignaling enzymes. 

liquid radiation therapy—an experimental way 

to deliver liquid radiation to the cavity that 

remains following tumor surgery. 

lobes—sections of each half of the brain that are involved in directing different neurological functions. 

lumbar puncture (LP)—a diagnostic procedure in 

which a sample of cerebrospinal fluid is removed 

from the spinal cord using a needle (also called a 

spinal tap). 

magnetic resonance imaging (MRI)—an imaging 

technique which uses radio waves, a magnetic field, 

and sophisticated computer analysis to create a 

picture of body tissues and structures. 
malignant—harmful, cancerous. Often used to 

describe tumor cells that are very different from 

normal cells, grow relatively quickly, and can 

easily spread to other locations. 

medulloblastoma—a malignant tumor most often 

seen in children and young adults that usually 

begins in the lower part of the brain and can 

spread throughout the brain and along the spine. 

meninges—three layers of membranes that cover 

the brain and spinal cord. These tissue layers, 

from closest to the skull to the brain, are: dura 

mater, arachnoid, and pia mater. 

meningioma—a tumor found in the meninges, 

the membranes that cover and protect the brain 

and spinal cord. 

metastatic—means “to spread.” Metastatic 

tumors are caused by cancerous cells that have 

spread from other parts of the body. 

monoclonal antibodies—laboratory-produced 

immune molecules that target and bind to a 

specific protein on cancer cells. 

neoplasm—a new, abnormal growth in the body. 

neuroblastoma—a mostly childhood tumor that 

appears in nerve tissue above the adrenal glands 

and can spread to other parts of the body. 

neurofibromatosis—a genetic disorder of the 

nervous system that causes tumors to grow 

around nerves. 

neurosurgery—surgery on the spine, brain, or 

other parts of the nervous system. 

57 
58 

occipital lobe—the brain part that receives and 

processes visual images and how we understand 

written words. 

oligodendroglioma—a type of brain tumor that 

develops from cells that produce myelin, the fatty 

covering over nerves. 

oncogene—a gene normally involved in cell 

growth that can, when altered, promote the 

uncontrolled growth of cancer. 

osmotic blood-brain barrier disruption— 

experimental treatment that uses different 

drugs to open blood vessels in the hopes of 

delivering more chemotherapeutic drugs 

across the blood-brain barrier and to the 

brain tumor. 

parietal lobe—a part of the brain that processes 

sensations. 

pathologist—a physician specially trained in 

diagnosing diseases by examining blood, tissues, 

and other body materials. 

pituitary tumor—a small, usually benign tumor 

that forms in the pituitary gland, which releases 

hormones that influence the body’s growth and 

metabolism. 

positron emission tomography (PET)—an 

imaging technique that provides a visual measure 

of metabolism, or activity, within body tissues. 

primary—a term used to describe a growth that 

begins in the organ in which it is originally formed 

and has not spread from elsewhere in the body. 
 

radiation therapy—the use of high-energy 

radiation to kill cancer cells. 

radiosensitizer—a drug that makes tumor cells 

more sensitive to radiation therapy. 

reflexes—automatic movements that the body 

makes in response to a given stimulus. 

resection—surgery to remove the tumor or 

dead tissue. 

schwannoma—a benign tumor that forms in 

the fatty sheath that covers nerve fibers. 

shunt—a flexible plastic tube that is used to 

divert the flow of cerebrospinal fluid from the 

central nervous system to another part of the 

body where it can be absorbed as part of the 

normal circulatory process. 

solid tumor—a localized growth of tissue 

(vs. a fluid-filled sac). 

spasticity—abnormal, involuntary stiffness or 

contraction of the body’s muscles. 

stereotactic radiosurgery—high-dose radiation 

therapy that is directed into the tumor while 

sparing normal tissue; it does not involve 

actual surgery. 

temporal lobe—the part of the brain that is 

involved with memory and understanding 

sounds and words. 

tomotherapy—an experimental form of radiation 

therapy that uses computer imaging to deliver 

small beams of high-dose radiation to the tumor 

from 360 degrees. 

59 
60 

tuberous sclerosis—a rare genetic disease that 

causes benign tumors to grow in the brain and 

on other vital organs such as the kidneys, heart, 

eyes, lungs, and skin. 

tumor—an abnormal mass of tissue that can be 

cancerous or noncancerous. 

vaccine therapy—a type of treatment that uses 

different substances to strengthen the normal 

immune system response to tumors and 

infectious materials. 

 

62 

Credits

John Heiss, M.D., Surgical Neurology Branch, NINDS—page 12



Russell Lonser, MD, Surgical Neurology Branch, NINDS—cover and 
 

Elizabeth W. Newcomb, PhD, Department of Pathology, NYU-School of 
 

Balazs Hegedus, PhD, and David H. Gutmann, MD, PhD,
 


Warren Grant Magnuson Clinical Center—page 14



pages 18, 35



National Cancer Institute—page 22



Medicine—page 28



NIH, Medical Arts—page 31



Department of Neurology, Washington University in St. Louis—page 40



Written by the Office of Communications and Public Liaison, NINDS
 

Patient participation in clinical research 

is critical to making new medication and 

therapies available for future use. Play a 

more active role in your own health care, 

gain access to new research treatments 

before they are widely available, and 

help others by volunteering for a medical 

research study.

Prepared by: 

Office of Communications and Public Liaison 

National Institute of Neurological Disorders and Stroke 

National Institutes of Health 

Department of Health and Human Services 

Bethesda, MD 20892-2540 

NIH Publication No. 09-504 

July 2009 

NINDS health-related material is provided for information 

purposes only. Advice on the treatment or care of an individual 

patient should be obtained through consultation with a physician 

who has examined that patient or is familiar with that patient’s 

medical history.