{"id":10236,"date":"2026-01-21T18:25:44","date_gmt":"2026-01-21T17:25:44","guid":{"rendered":"https:\/\/neurohirurgija.in.rs\/?page_id=10236"},"modified":"2026-06-03T11:09:43","modified_gmt":"2026-06-03T09:09:43","slug":"brain-tumors","status":"publish","type":"page","link":"https:\/\/neurohirurgija.in.rs\/en\/brain-tumors\/","title":{"rendered":"Brain Tumors \u2014 Types, Symptoms, Diagnosis, and Treatment"},"content":{"rendered":"\n<div style=\"line-height:1.35; margin:0 0 18px 0;\">\n  <div>\n    <span style=\"font-weight:600;\">Author:<\/span>\n    <a href=\"https:\/\/neurohirurgija.in.rs\/en\/cv-en\/\" \n       style=\"color:#004a80; font-weight:600; text-decoration:none;\"\n       onmouseover=\"this.style.textDecoration='underline';\"\n       onmouseout=\"this.style.textDecoration='none';\">\n       Dr. Zeljko Kojadinovic, MD, PhD\n    <\/a>\n    \u2014 Neurosurgeon and Pain Management Specialist\n  <\/div>\n\n  <div>\n    <span style=\"font-weight:600;\">Specialized Experience:<\/span>\n    30 years of clinical expertise in neurosurgery.\n  <\/div>\n\n  <div>\n    <span style=\"font-weight:600;\">Last medically reviewed:<\/span>\n    January 6, 2026\n  <\/div>\n<\/div>\n\n\n\n<div style=\"background:#fff7cc; border:1px solid #ffe08a; padding:12px; border-radius:8px; margin:16px 0;\">\n  <div style=\"font-weight:700; color:#5a4b00; font-size:16px; margin-bottom:6px;\">\n    <h3 id=\"who-this-brain-tumors-page-is-for\">Who This Brain Tumors Page Is For<\/h3>\n  <\/div>\n\n  <p style=\"margin:0; color:#3b2f00; line-height:1.5;\">\n    This brain tumors overview page is designed primarily for patients who have been diagnosed with a brain tumor (or told they may have one), as well as for family members seeking to understand imaging findings and treatment options.\n    <br><br>\n    It is especially intended for those who were told that the situation is \u201ccomplex,\u201d \u201chigh risk,\u201d or \u201cuncertain,\u201d \n    and who want to understand what different tumor types mean, how diagnosis is established, \n    when surgery is indicated, and how modern treatment decisions are made using imaging, pathology, and molecular markers.\n    <br><br>\n    The page explains core concepts such as benign versus malignant tumors, infiltrative growth, brain edema and mass effect, \n    the role of MRI and advanced imaging, surgical strategies (maximum safe resection, biopsy, awake surgery), \n    and how radiation and chemotherapy are integrated into treatment plans.\n    <br><br>\n    If the information raises questions about diagnosis, operability, prognosis, or whether the proposed treatment strategy is optimal, \n    you may contact us to see how we provide an individualized\n    <a href=\"https:\/\/neurohirurgija.in.rs\/en\/second-opinion-in-neurosurgery-trusted-insight\/\" target=\"_blank\" rel=\"noopener\" style=\"color:#005c99; text-decoration:underline;\">\n      neurosurgery second opinion\n    <\/a>\n    tailored to your specific case.\n    <br><br>\n     <\/p>\n<\/div>\n\n\n\n<div style=\"border: 1px solid #d6d6d6; border-radius: 12px; padding: 16px; margin: 18px 0 10px; background: #f7f7f7;\">\n  \n  <div style=\"font-weight: 700; margin-bottom: 12px;\">\n    When patients and families usually seek a neurosurgical second opinion for brain tumors\n  <\/div>\n\n  <div style=\"font-size: 0.98em; line-height: 1.55;\">\n    <div style=\"margin-bottom: 6px;\">\u2022 The diagnosis feels complex or difficult to understand<\/div>\n    <div style=\"margin-bottom: 6px;\">\u2022 Surgery is described as high risk or \u201cnot recommended\u201d<\/div>\n    <div style=\"margin-bottom: 6px;\">\u2022 Treatment options seem unclear or contradictory<\/div>\n    <div style=\"margin-bottom: 6px;\">\u2022 The tumor was found incidentally, and the current recommendation is \u201cwatch and monitor\u201d (active surveillance)<\/div>\n    <div>\u2022 Imaging, pathology, or molecular findings raise new questions<\/div>\n  <\/div>\n\n  <div style=\"margin-top: 12px; font-size: 0.98em; line-height: 1.45;\">\n    In neuro-oncology, seeking an independent expert opinion is a common and responsible step.\n    If this reflects your situation, you can request an individualized neurosurgical review here:\n    <a href=\"#request-brain-tumor-second-opinion\" style=\"font-weight: 700; text-decoration: underline;\">\n      Request Second Opinion\n    <\/a>\n  <\/div>\n\n<\/div>\n\n\n\n<style>\n\/* === BRAIN TUMORS TOC \u2013 BLUE COLLAPSIBLE BOX === *\/\n.ptns-toc-simple {\n    max-width: 420px;\n    margin: 0 0 26px 0;\n    font-family: system-ui, -apple-system, \"Segoe UI\", Roboto, Arial, sans-serif;\n}\n.ptns-toc-simple .card {\n    background: #f4faff;\n    border: 1px solid #cce5ff;\n    border-radius: 12px;\n    padding: 14px;\n    box-shadow: 0 10px 22px rgba(0, 60, 120, 0.08);\n}\n.ptns-toc-simple summary {\n    list-style: none;\n    cursor: pointer;\n    display: flex;\n    align-items: center;\n    justify-content: space-between;\n    gap: 12px;\n    padding: 0;\n    margin: 0 0 10px 0;\n}\n.ptns-toc-simple summary::-webkit-details-marker { display: none; }\n.ptns-toc-simple .title {\n    font-weight: 800;\n    font-size: 22px;\n    color: #003a66;\n    margin: 0;\n}\n.ptns-toc-simple summary::after {\n    content: \"\u25b8 Show\";\n    font-weight: 700;\n    color: #005c99;\n    border: 1px solid rgba(0, 92, 153, 0.25);\n    padding: 6px 10px;\n    border-radius: 6px;\n    font-size: 13px;\n}\n.ptns-toc-simple details[open] summary::after { content: \"\u25be Hide\"; }\n\n.ptns-toc-simple ul { margin: 0; padding: 0; list-style: none; }\n.ptns-toc-simple li {\n    position: relative;\n    padding-left: 26px;\n    margin: 9px 0;\n    line-height: 1.25;\n    font-size: 16px;\n}\n.ptns-toc-simple li::before {\n    content: \"\";\n    width: 7px;\n    height: 7px;\n    border-radius: 50%;\n    background: #005c99;\n    position: absolute;\n    left: 8px;\n    top: 9px;\n}\n.ptns-toc-simple .sub-item { padding-left: 44px; }\n.ptns-toc-simple .sub-item::before { left: 26px; }\n\n.ptns-toc-simple a {\n    color: #003a66;\n    text-decoration: none;\n    font-weight: 700;\n}\n.ptns-toc-simple a:hover { text-decoration: underline; }\n\n@media (max-width: 991px) {\n    .ptns-toc-simple { max-width: 100%; }\n    .ptns-toc-simple li { font-size: 15px; }\n}\n<\/style>\n\n<div class=\"ptns-toc-simple\" aria-label=\"Table of contents\">\n  <div class=\"card\">\n    <details>\n      <summary>\n        <h3 class=\"title\">Contents<\/h3>\n      <\/summary>\n\n      <ul>\n        <li><a href=\"#who-this-brain-tumors-page-is-for\">Who This Page Is For<\/a><\/li>\n\n        <li style=\"margin-top:15px;\"><a href=\"#tumor-types\">100+ Tumor Types<\/a><\/li>\n        \n        <li style=\"margin-top:15px;\"><a href=\"#causes\">Causes Overview<\/a><\/li>\n        \n        <li style=\"margin-top:15px;\"><a href=\"#malignancy-grades\">WHO Grades<\/a><\/li>\n        <li><a href=\"#growth-pattern\">Growth Patterns<\/a><\/li>\n\n        <li style=\"margin-top:15px;\"><a href=\"#symptoms\">Key Symptoms<\/a><\/li>\n<li style=\"margin-top:15px;\">   <a href=\"#karnofsky-performance-status\">Functional Status (Karnofsky Score)<\/a>\n<\/li>\n\n\n        <li style=\"margin-top:15px;\"><a href=\"#diagnosis\">Diagnosis (MRI)<\/a><\/li>\n        \n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#treatment\">Treatment Strategy<\/a><\/li>\n      \n        <li class=\"sub-item\"><a href=\"#surgical-treatment\">Surgery Options<\/a><\/li>\n<li class=\"sub-item\"><a href=\"#surgery-vs-biopsy\">Surgery vs Biopsy<\/a><\/li>\n        \n        <li class=\"sub-item\"><a href=\"#results-of-surgical-treatment\">Surgery Outcomes<\/a><\/li>\n\n        <li style=\"margin-top:15px;\"><a href=\"#ph-analysis\">Pathology &#038; Markers<\/a><\/li>\n\n               <li class=\"sub-item\"><a href=\"#radiation-therapy\">Radiation Therapy<\/a><\/li>\n        <li class=\"sub-item\"><a href=\"#chemotherapy\">Chemo &#038; Targeted<\/a><\/li>\n\n        <li style=\"margin-top:15px;\"><a href=\"#alternative-treatment\">Complementary Methods<\/a><\/li>\n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#gliomas\">Gliomas<\/a><\/li>\n        \n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#meningeomas\">Meningiomas<\/a><\/li>\n       \n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#schwannomas\">Schwannomas<\/a><\/li>\n      \n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#pituitary-tumors\">Pituitary Tumors<\/a><\/li>\n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#brain-metastases\">Brain Metastases<\/a><\/li>\n        \n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#brain-tumors-in-children\">Pediatric Tumors<\/a><\/li>\n\n        <li style=\"margin-top:15px;font-weight:800;\"><a href=\"#request-brain-tumor-second-opinion\">Request Consultation<\/a><\/li>\n\n        <li><a href=\"#faq-brain-tumors\">Brain Tumor FAQs<\/a><\/li>\n\n        <li style=\"margin-top:15px;\"><a href=\"#patient-friendly-sources\">Patient Resources<\/a><\/li>\n        <li class=\"sub-item\"><a href=\"#mas-score\">MAS (PubMed)<\/a><\/li>\n      <\/ul>\n    <\/details>\n  <\/div>\n<\/div>\n\n<style>\nh2, h3 { scroll-margin-top: 110px; }\n<\/style>\n\n\n\n<h2 id=\"tumor-types\" class=\"wp-block-heading\">There Are More Than 100 Types of Tumors That Can Grow Inside the Skull<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <strong>World Health Organization (WHO 2021)<\/strong> classification and the <strong>CBTRUS (latest edition)<\/strong> report, there are over <strong>100 distinct types of tumors<\/strong> that can develop inside the skull. These are broadly classified into two categories: <strong>Primary<\/strong> and <strong>Secondary (Metastatic)<\/strong> tumors.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In clinical practice, more than 90% of adult cases are represented by the following groups:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Primary Brain Tumors<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">These tumors originate from the brain tissue or its surrounding structures.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Gliomas:<\/strong> This is the most critical group of primary tumors, including <a href=\"https:\/\/neurohirurgija.in.rs\/en\/astrocytoma-brain-tumor\/\">astrocytomas<\/a>, <a href=\"https:\/\/neurohirurgija.in.rs\/en\/oligodendroglioma\/\">oligodendrogliomas<\/a>, and glioblastomas. Notably, <strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/glioblastoma-gbm\/\">glioblastoma<\/a> is the most common and aggressive primary malignant brain tumor<\/strong>, accounting for <strong>more than 50% of malignant primary brain tumors<\/strong>, and approximately <strong>~14% of all primary intracranial tumors when benign entities are included<\/strong>.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/meningiomas\/\">Meningiomas<\/a>:<\/strong> These arise from the protective membranes covering the brain. They are the most frequent primary brain tumors, representing between <strong>35% and 41%<\/strong> of all primary cases.<\/li>\n\n\n\n<li><strong>Pituitary Adenomas:<\/strong> These tumors grow in the pituitary gland at the base of the skull and account for approximately ~10\u201315% of primary brain tumors.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/vestibular-schwannoma\/\">Schwannomas (Neurinomas)<\/a>:<\/strong> These develop from nerve sheaths (most often the acoustic nerve) and make up roughly <strong>~5\u201310%<\/strong> of primary intracranial tumors.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Secondary Brain Tumors (<a href=\"https:\/\/neurohirurgija.in.rs\/en\/brain-metastases\/\">Metastases<\/a>)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Secondary tumors, or metastases, are cancers that have spread to the brain from distant organs (such as the lungs, breast, or kidney).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Incidence:<\/strong> In clinical practice, metastases are the most common tumors found inside the skull, accounting for approximately <strong>50% of all intracranial tumors<\/strong> in adults.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"causes\" class=\"wp-block-heading\">Causes of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Brain tumors, like other tumors in the body, arise as a consequence of changes (mutations) in specific genes of normal cells. During these changes, two primary types of genes are affected:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Proto-oncogenes: In a healthy cell, these genes function only at strictly controlled levels. <strong>When they mutate<\/strong> into oncogenes, they become permanently active. This triggers accelerated <strong>cell division and <\/strong>allows tumor cells to become <strong>increasingly autonomous, <\/strong>meaning they no longer respond to the external regulatory signals that normally control cell growth. Functionally, this process resembles a \u201cgas pedal\u201d that is stuck in the pressed position.<\/li>\n\n\n\n<li><strong>Tumor Suppressor Genes<\/strong>: Their role is to inhibit uncontrolled cell multiplication. When these genes become inactivated by mutation, the cell loses its natural \u201cbrakes.\u201d<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Such genetic changes occur constantly in the human body in a large number of cells, but in most cases, the immune system recognizes and neutralizes them. However, in situations where these cells escape immune control and continue to multiply uncontrollably, tumor formation occurs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Initially, a tumor is often <strong>benign<\/strong> (non-cancerous), but over time, <strong>additional genetic mutations may accumulate<\/strong>, giving the tumor increasingly aggressive characteristics and allowing it to transform into a <strong>malignant<\/strong> form. <strong>The reasons why these additional genetic changes occur are not always fully known.<\/strong> However, it is important to note that some of the most aggressive tumors, such as <strong>Glioblastomas<\/strong>, are often <strong>malignant from the very beginning<\/strong> (known as <em>de novo<\/em> tumors) and do not pass through a detectable benign stage. While we understand the cellular mechanisms, the exact triggers that initiate these initial or cumulative mutations remain a subject of intensive research.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heredity and Genetic Predisposition<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In a small number of people, there are inherited syndromes (such as Neurofibromatosis) that increase the risk. However, it is important to clarify that while <strong>all individuals inherit normal proto-oncogenes and tumor suppressor genes<\/strong>, the vast majority of brain <strong>tumors arise from somatic mutations acquired during life and are not inherited<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Influence of External Factors on the Origin of Brain Tumors<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The influence of external factors is still being intensively studied. Current scientific knowledge indicates the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ionizing Radiation:<\/strong> Exposure to high-dose radiation is a well-established risk factor for developing brain tumors.<\/li>\n\n\n\n<li><strong>Infections and Inflammation:<\/strong> Researchers are investigating the role of <strong>prior viral infections<\/strong> and <strong>long-term inflammatory processes<\/strong>, though results are not yet conclusive for most tumor types.<\/li>\n\n\n\n<li><strong>Chemicals:<\/strong> Exposure to certain pesticides and industrial chemicals continues to be monitored as a potential risk factor.<\/li>\n\n\n\n<li><strong>Stress and Lifestyle:<\/strong> Patients frequently ask about <strong>stress, head injuries, overwork, or the use of mobile phones<\/strong>. At present, there is <strong>no scientific evidence<\/strong> that these factors directly cause brain tumors, but their possible long-term effects continue to be tracked in large-scale studies.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"malignancy-grades\" class=\"wp-block-heading\">Classification of Brain Tumors by Malignancy<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Based on how rapidly they progress and the percentage of cases in which they can be cured, these tumors are classified as <strong>benign (non-cancerous)<\/strong> or <strong>malignant (cancerous)<\/strong>. This classification is further refined into <strong>WHO grades (I\u2013IV)<\/strong>, where higher grades indicate more aggressive growth and a greater tendency to invade healthy tissue. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Meningiomas, neurinomas, and pituitary adenomas are most often benign. Metastases are always the result of malignant disease, while gliomas are more often malignant. One type of glioma\u2014<strong>glioblastoma<\/strong>\u2014is the most common malignant brain tumor.<\/p>\n\n\n\n<h2 id=\"growth-pattern\" class=\"wp-block-heading\">Classification by Growth Pattern of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">According to their growth behavior, tumors can be divided into those that, by their growth, <strong>only compress surrounding parts of the brain<\/strong>, and those that <strong>infiltrate (invade) surrounding brain tissue<\/strong>, as well as combined forms.<br>(For example, large malignant tumors infiltrate the brain and also exert pressure on it.). Additionally, many tumors cause <strong>brain edema (swelling)<\/strong> by leaking fluid into the surrounding area, which increases intracranial pressure and often intensifies neurological symptoms.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"328\" height=\"336\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma.jpg\" alt=\" A meningioma growing from the coverings of the brain and compressing surrounding parts of the brain, without infiltrating them.\" class=\"wp-image-10260\" style=\"aspect-ratio:0.9761893689252662;width:446px;height:auto\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma.jpg 328w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma-293x300.jpg 293w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma-12x12.jpg 12w\" sizes=\"auto, (max-width: 328px) 100vw, 328px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: A meningioma growing from the coverings of the brain and compressing surrounding parts of the brain, without infiltrating them.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"599\" height=\"558\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Infiltracija.jpg\" alt=\"A cross-section of the two cerebral hemispheres. In one hemisphere there is a large malignant glioma (approximately 4 centimeters in diameter). Tumor cells have already penetrated into the wider surrounding area (even into the opposite hemisphere) by infiltration.\" class=\"wp-image-133\" style=\"aspect-ratio:1.0734787600459241;width:461px;height:auto\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Infiltracija.jpg 599w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Infiltracija-300x279.jpg 300w\" sizes=\"auto, (max-width: 599px) 100vw, 599px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: A cross-section of the two cerebral hemispheres. In one hemisphere there is a large malignant glioma (approximately 4 centimeters in diameter). Tumor cells have already penetrated into the wider surrounding area (even into the opposite hemisphere) by infiltration.<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"symptoms\" class=\"wp-block-heading\">Symptoms of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">When a tumor reaches a significant size, it exerts pressure on the surrounding brain tissue, causes brain swelling, disrupts blood circulation in nervous tissue, and may also lead to bleeding. The mechanisms by which a tumor damages nervous tissue are numerous and overlap with each other.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All of this results in symptoms such as <strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/headache-when-to-worry\/\">headache<\/a>, <a href=\"https:\/\/neurohirurgija.in.rs\/en\/epilepsy-surgery-when-it-is-the-right-option\/\">epilepsy<\/a> (seizures), drowsiness<\/strong>, and various deficits in brain and cranial nerve function. The functional deficits depend on the tumor\u2019s location and size. These may include disorders of <strong>vision, speech, hearing, smell, movement of the limbs, balance, sense of touch, and psychiatric disturbances<\/strong>, \u2026<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In benign tumors, <strong>one or several symptoms usually appear first,<\/strong> and then\u2014<strong>for months or even years\u2014no new symptoms develop<\/strong> despite continued tumor growth. Because of their slow growth, additional symptoms typically emerge only when the tumor becomes large enough to compress adjacent neural structures. A typical example is a <strong>vestibular schwannoma<\/strong> (acoustic neuroma), which often initially causes hearing loss and balance disturbances on one side. For a long time, these may remain the only symptoms. Additional neurological deficits usually appear only later, when the tumor grows sufficiently to compress neighboring cranial nerves or the brainstem.<\/p>\n\n\n\n<h3 id=\"karnofsky-performance-status\">Functional Status and the Karnofsky Performance Scale (KPS)<\/h3>\n\n<p>\nIn patients with malignant brain tumors, symptoms alone are not sufficient to assess disease severity or to guide treatment decisions.\nEqually important is the patient\u2019s functional status \u2014 how the tumor affects daily activity, independence, and overall physical condition.\n<\/p>\n\n<p>\nOne of the most widely used tools in neuro-oncology for this purpose is the <strong>Karnofsky Performance Status (KPS)<\/strong>.\nKPS plays a central role in the evaluation of malignant brain tumors because it directly influences:\n<\/p>\n\n<ul>\n  <li>assessment of overall disease severity and biological impact<\/li>\n  <li>indications for surgical treatment and operability<\/li>\n  <li>eligibility for radiation therapy and chemotherapy<\/li>\n  <li>tolerance of aggressive treatment protocols<\/li>\n  <li>interpretation of treatment results and prognosis<\/li>\n<\/ul>\n\n<p>\nIn high-grade gliomas and other malignant tumors, a lower Karnofsky score often reflects both tumor aggressiveness\nand the extent of functional brain involvement.\nFor this reason, KPS is a key parameter in balancing surgical radicality with preservation of quality of life.\n<\/p>\n\n<table style=\"border-collapse: collapse; width: 100%; margin: 16px 0;\">\n  <thead>\n    <tr style=\"background:#f4faff;\">\n      <th style=\"border:1px solid #ccc; padding:8px; text-align:left;\">Karnofsky Score<\/th>\n      <th style=\"border:1px solid #ccc; padding:8px; text-align:left;\">Functional Meaning<\/th>\n    <\/tr>\n  <\/thead>\n  <tbody>\n    <tr>\n      <td style=\"border:1px solid #ccc; padding:8px;\"><strong>90\u2013100<\/strong><\/td>\n      <td style=\"border:1px solid #ccc; padding:8px;\">Normal activity or only minor symptoms<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"border:1px solid #ccc; padding:8px;\"><strong>70\u201380<\/strong><\/td>\n      <td style=\"border:1px solid #ccc; padding:8px;\">Independent, but unable to carry out normal work<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"border:1px solid #ccc; padding:8px;\"><strong>50\u201360<\/strong><\/td>\n      <td style=\"border:1px solid #ccc; padding:8px;\">Requires assistance and frequent medical care<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"border:1px solid #ccc; padding:8px;\"><strong>&lt; 50<\/strong><\/td>\n      <td style=\"border:1px solid #ccc; padding:8px;\">Severe disability, limited self-care<\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n\n<p>\nIt is important to note that the Karnofsky score does not define tumor malignancy by itself.\nRather, it reflects the functional consequences of the disease and is interpreted together with imaging,\npathohistological findings, and molecular markers to guide individualized treatment decisions.\n<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"diagnosis\" class=\"wp-block-heading\">Diagnosis of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Because small tumors are significantly easier to treat than large ones, early diagnosis is critical. The gold standard and most important diagnostic method is <strong>Magnetic Resonance Imaging (MRI)<\/strong> of the brain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">With the widespread availability of MRI scanners today, this examination should be performed at the onset of any symptoms suggesting a potential tumor. This includes cases of sensorineural hearing loss, new-onset epilepsy, disorders of smell or vision, and unexplained psychiatric disturbances.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure is painless and typically lasts between <strong>15 and 45 minutes<\/strong>. It requires the patient to remain still in a confined space while being exposed to rhythmic noise. For patients with claustrophobia or severe anxiety, the imaging can be performed under <strong>sedation or light anesthesia<\/strong> to ensure comfort and image quality. For brain tumors, an MRI is typically performed both before and after the <strong>administration of a contrast<\/strong> agent. Therefore, kidney function is assessed and an intravenous (IV) line is placed prior to the scan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>MRI scan reveals<\/strong> the tumor&#8217;s<strong> location, size, and probable type<\/strong>, its <strong>relationship with critical surrounding structures<\/strong> (e.g., functional centers, major white matter tracts, blood vessels, and nerves), as well as the presence of <strong>complications<\/strong> (<a href=\"https:\/\/neurohirurgija.in.rs\/en\/mass-effect-midline-shift-brain-herniation-explained\/\">mass effect<\/a>, herniation, ischemia, <a href=\"https:\/\/neurohirurgija.in.rs\/en\/ich-when-to-operate\/\">hemorrhage<\/a>, hydrocephalus, etc.). These tumor characteristics determine the neurosurgeon&#8217;s operative approach; this is why <strong>neurosurgeons often examine the imaging data through different eyes than radiologists.<\/strong> For this reason, unlike other medical specialties, a radiologist\u2019s written report alone is never sufficient for a neurosurgeon.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Advanced and Additional Diagnostic Methods<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Beyond standard MRI, specialized imaging techniques are often used to refine the diagnosis and plan surgical interventions:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Functional MRI (fMRI):<\/strong> Maps the relationship between the tumor and vital brain centers (e.g., speech or motor functions).<\/li>\n\n\n\n<li><strong>MRI Spectroscopy (MRS):<\/strong> Helps differentiate the tumor type and grade before surgery by analyzing chemical metabolites.<\/li>\n\n\n\n<li><strong>MR Angiography (MRA):<\/strong> Visualizes the blood vessels surrounding or feeding the tumor.<\/li>\n\n\n\n<li><strong>MR Tractography (DTI):<\/strong> Visualizes white matter pathways to help plan the safest surgical approach.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Other diagnostic tools may include <strong>Computed Tomography (CT)<\/strong>, EEG, evoked potentials, endocrine (hormonal) evaluations, and specialized vision or hearing tests. In some cases, skeletal scintigraphy (bone scans) may be required to detect systemic involvement.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"281\" height=\"257\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma2MRI.jpg\" alt=\"Brain MRI showing a meningioma in the right parietal region, causing a significant mass effect on the brain due to its size and surrounding edema.\" class=\"wp-image-10302\" style=\"width:686px;height:auto\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma2MRI.jpg 281w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/meningeoma2MRI-13x12.jpg 13w\" sizes=\"auto, (max-width: 281px) 100vw, 281px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: Brain MRI showing a meningioma in the right parietal region, causing a significant mass effect on the brain due to its size and surrounding edema.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Comprehensive Medical Evaluation<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">It is essential to conduct a full oncologic evaluation (imaging of other organs) to determine if the brain tumor is primary or a metastasis from elsewhere in the body. Furthermore, assessing the patient\u2019s overall health is vital for safe anesthesia and personalized treatment planning.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At a minimum, the following preoperative assessments are required: <strong>comprehensive blood and urine laboratory tests, ECG, chest X-ray, and an abdominal ultrasound.<\/strong> Depending on the patient\u2019s medical history, additional specialist consultations\u2014such as cardiologic, urologic, or gynecologic evaluations\u2014may be performed.<\/p>\n\n\n\n<h2 id=\"treatment\" class=\"wp-block-heading\">Treatment of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Once a brain tumor is diagnosed, a <strong>multidisciplinary team of specialists<\/strong> (often referred to as a Neuro-Oncology Board) evaluates the case to determine the most effective treatment plan. The available options generally fall into three categories: <strong>symptomatic treatment, surgical intervention, and adjuvant therapy<\/strong> (such as radiation or chemotherapy).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The treatment strategy is based on the latest neuro-oncological clinical guidelines and the patient&#8217;s overall health. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In specific situations\u2014most often in elderly patients or in those with significant comorbidities\u2014a brain tumor may be stable and not currently impairing brain function. In such cases, immediate active treatment is not always necessary. In everyday neuro-oncological practice, <strong>approximately one quarter of newly diagnosed intracranial tumors are initially managed with active surveillance<\/strong> rather than surgery or adjuvant therapy. This approach is especially common for tumors that are small, slow-growing, and not causing relevant mass effect or neurological deficits.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Typical examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>small vestibular schwannomas, particularly when hearing is still preserved<\/li>\n\n\n\n<li>calcified or minimally growing meningiomas, especially in older patients<\/li>\n\n\n\n<li>non-functioning pituitary adenomas that show no progression on follow-up imaging<\/li>\n\n\n\n<li>selected low-grade or diffuse gliotic infiltrations, particularly in pediatric patients<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Active surveillance <\/strong>involves structured follow-up with periodic MRI examinations and clinical assessment. The goal is not to avoid treatment, but to postpone invasive interventions until there is clear evidence of tumor growth, new symptoms, or functional compromise.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Symptomatic Treatment of Brain Tumors<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Symptomatic treatment is administered to manage complications caused by the tumor\u2019s presence, such as brain swelling, headaches, seizures (epilepsy), and vomiting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To manage <strong>brain edema (swelling)<\/strong>, <strong>corticosteroids<\/strong> (most commonly Dexamethasone\/Dexason) are prescribed. These medications are typically administered via injection or in tablet form. Because long-term corticosteroid use can affect the digestive system, medications to protect the stomach lining are often prescribed concurrently. Additionally, patients experiencing seizures are treated with <strong>anti-epileptic drugs (AEDs)<\/strong> to stabilize electrical activity in the brain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In certain situations, <strong>symptomatic (palliative) treatment <\/strong>represents the only appropriate therapeutic approach. This most often applies to patients with <strong>very aggressive malignant brain tumors<\/strong> who have a severely reduced Karnofsky Performance Status (KPS), indicating profound functional impairment. In such cases, the risks of surgery, radiation, or chemotherapy clearly outweigh any potential benefit, and active oncological treatment would not improve survival or quality of life. A similar approach is taken in patients with advanced systemic malignancies with brain involvement, where the overall prognosis is poor and neurological symptoms are part of a widespread disease process. In these circumstances,<strong> treatment is focused exclusively on symptom control and comfort<\/strong> \u2014 reducing <a href=\"https:\/\/neurohirurgija.in.rs\/en\/brain-edema-explained\/\">brain edema<\/a>, relieving pain, controlling <a href=\"https:\/\/neurohirurgija.in.rs\/en\/seizures-after-brain-injury\/\">seizures<\/a>, managing agitation or confusion, and supporting basic neurological function. The primary goal is to preserve dignity, minimize suffering, and maintain the best possible quality of life for the remaining time.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"surgical-treatment\" class=\"wp-block-heading\">Surgical Treatment of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical treatment involves <strong>opening the skull<a href=\"https:\/\/neurohirurgija.in.rs\/en\/craniotomy-explained\/\"> (craniotomy)<\/a><\/strong>, reaching the tumor, and removing it. During the procedure, vital surrounding structures\u2014such as healthy brain tissue, cranial nerves, and blood vessels\u2014must be carefully separated from the tumor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Total removal is often <strong>impossible<\/strong> if the tumor grows infiltratively, which is common in most gliomas and aggressive malignant variants of other tumor types. Furthermore, if a benign tumor becomes very large, it may thin and adhere to surrounding structures so strongly that separating them without causing functional damage becomes impossible. This highlights the critical importance of early diagnosis while the tumor is still small.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Depending on the tumor&#8217;s relationship with the surrounding brain, the surgeon performs either:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Complete removal (ablation):<\/strong> Total excision of the tumor mass.<\/li>\n\n\n\n<li><strong>Partial removal (reduction\/debulking):<\/strong> This involves removing the majority of the tumor to relieve pressure while leaving small remnants or infiltrative parts to protect vital functions. Thanks to advanced techniques such as <strong>stereotactic radiation<\/strong>, these small remnants of <strong>benign tumors<\/strong> can be effectively controlled to prevent further growth or even be significantly reduced in size. For <strong>infiltrative and malignant<\/strong> forms, adjuvant therapy (radiation and\/or chemotherapy) must be performed according to the specific treatment protocol for that tumor type.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In high-risk cases where surgery is too dangerous or diagnosis is uncertain, only<strong> tumor samples (biopsy)<\/strong> are taken to determine the exact type of tumor. This is often performed <strong>stereotactically<\/strong>, using precision guidance systems. The procedure involves inserting a specialized biopsy needle through a small burr hole in the skull, guided with sub-millimeter accuracy by a <strong>stereotactic frame or neuronavigation (frameless stereotaxy).<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Modern Surgical Technologies in Brain Tumor Surgery<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">To ensure the best possible outcome, surgery should be performed <strong>by a specialist with extensive microsurgical experience. <\/strong>Surgical plan depends mostly on: the tumor&#8217;s<strong> location, size, and probable type<\/strong>, its <strong>relationship with critical surrounding structures<\/strong> (e.g., functional centers, major white matter tracts, blood vessels, and nerves), as well as the presence of <strong>complications<\/strong> (<a href=\"https:\/\/neurohirurgija.in.rs\/en\/mass-effect-midline-shift-brain-herniation-explained\/\">mass effect<\/a>, herniation, ischemia, <a href=\"https:\/\/neurohirurgija.in.rs\/en\/ich-when-to-operate\/\">hemorrhage<\/a>, hydrocephalus, etc.).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Modern neurosurgery utilizes advanced technologies to make procedures more precise and safer:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Neuronavigation (Intraoperative GPS):<\/strong> Using MRI\/CT data and ultrasound to navigate precisely to deep-seated tumors.<\/li>\n\n\n\n<li><strong>Fluorescence-guided surgery:<\/strong> Using special dyes (like 5-ALA) that make tumor cells &#8222;glow&#8220; under the microscope to distinguish them from healthy brain tissue.<\/li>\n\n\n\n<li><strong>Intraoperative Neurophysiological Monitoring (IONM):<\/strong> Continuous monitoring of nerve functions during surgery to prevent paralysis or sensory loss.<\/li>\n\n\n\n<li><strong>Ultrasonic Aspirator (CUSA):<\/strong> A tool that uses ultrasonic vibrations to fragment and remove tumors while sparing blood vessels and nerves.<\/li>\n\n\n\n<li><strong>Awake Craniotomy:<\/strong> Performed on tumors near the speech or motor centers. This allows the surgeon to interact with the patient during the procedure to ensure vital functions remain intact.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Read more about potential complications following craniotomy and open brain surgery on this&nbsp;<a href=\"https:\/\/neurohirurgija.in.rs\/en\/craniotomy-brain-surgery-complications\/\">page<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"284\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Craniotomy2.jpg\" alt=\"The image illustrates a craniotomy. Both the skin incision and the skull opening are performed within the hair-bearing area of the scalp. The dura is opened to expose the brain as part of the surgical approach to the tumor. After the procedure, the bone flap is secured and the scalp is reconstructed, ensuring no cosmetic defect remains after healing.\" class=\"wp-image-10304\" style=\"aspect-ratio:1.4084731774415407;width:561px;height:auto\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Craniotomy2.jpg 400w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Craniotomy2-300x213.jpg 300w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Craniotomy2-18x12.jpg 18w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: The image illustrates a craniotomy. Both the skin incision and the skull opening are performed within the hair-bearing area of the scalp. The dura is opened to expose the brain as part of the surgical approach to the tumor. After the procedure, the bone flap is secured and the scalp is reconstructed, ensuring no cosmetic defect remains after healing.<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"surgery-vs-biopsy\" class=\"wp-block-heading\">Surgery vs Biopsy: clinical indications and limitations<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The decision between surgical resection and biopsy in brain tumors is based on <strong>tumor extent, surgical risk, expected benefit of non-surgical therapy, and the need for precise biological diagnosis<\/strong>. Surgery is not automatically the best option and, in many cases, is intentionally avoided or postponed for well-defined medical reasons.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When surgery is not indicated because of tumor extent<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical resection is not indicated when the tumor is <strong>extensive or diffusely infiltrative<\/strong>, making meaningful cytoreduction impossible. Typical examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Butterfly glioblastoma<\/strong> crossing the corpus callosum<\/li>\n\n\n\n<li>diffuse high-grade gliomas with bilateral hemispheric involvement<\/li>\n\n\n\n<li>tumors with widespread deep white-matter or subependymal spread<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In these situations, surgery does not improve survival or functional outcome and exposes the patient to significant neurological risk. <strong>Biopsy is required<\/strong> to establish histopathological and molecular diagnosis necessary for adjuvant treatment planning.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When surgery is avoided because it is neurologically dangerous<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Surgery may be avoided or intentionally limited when the tumor is located in <strong>critical or eloquent brain regions<\/strong>, where resection carries a high risk of permanent neurological deficit, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>the brainstem<\/li>\n\n\n\n<li>deep basal ganglia or thalamus<\/li>\n\n\n\n<li>eloquent cortex responsible for speech, movement, or vision<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Here, the limitation is <strong>surgical risk<\/strong>, not lack of treatment intent. Biopsy enables diagnostic certainty while preserving neurological function.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When adjuvant therapy offers greater benefit than immediate surgery<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In certain tumors, <strong>primary non-surgical treatment provides superior outcomes<\/strong>, and surgical resection would not alter management. Examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>primary CNS lymphoma<\/li>\n\n\n\n<li>tumors with high radiosensitivity or chemosensitivity<\/li>\n\n\n\n<li>cases where molecular profiling primarily determines therapy<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In such cases, surgery is not avoided because it is impossible, but because it <strong>does not add therapeutic value beyond diagnosis<\/strong>. Biopsy is essential to guide definitive treatment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When biopsy is necessary as preparation for surgery<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Biopsy is not limited to non-surgical cases. In selected situations, it represents a <strong>necessary preparatory step<\/strong> even when surgery is being considered.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Histopathological and molecular analysis may be required to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>confirm tumor type and grade<\/li>\n\n\n\n<li>identify molecular markers with prognostic and therapeutic relevance<\/li>\n\n\n\n<li>determine whether surgery is indicated at all<\/li>\n\n\n\n<li>define the timing and safe extent of resection<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Biopsy results may support delayed surgery, limited resection, or initiation of preoperative therapy before any operative intervention.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When surgery provides clear therapeutic benefit<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical resection is indicated when it is expected to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>significantly reduce tumor burden<\/li>\n\n\n\n<li>relieve mass effect or intracranial hypertension<\/li>\n\n\n\n<li>improve neurological symptoms<\/li>\n\n\n\n<li>enhance the effectiveness of adjuvant radiotherapy or chemotherapy<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In these situations, surgery remains a central component of multimodal treatment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Final clinical perspective<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Biopsy is not a lesser option but a necessary step in cases where resection is not indicated.<\/strong><br>When surgical removal is unsafe, unlikely to provide benefit, or would not change the therapeutic strategy, biopsy represents the most responsible and medically correct decision.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Histopathological and molecular analysis obtained through biopsy directly guides adjuvant therapy and has clear prognostic and therapeutic implications.<\/strong><br>Modern neuro-oncology is no longer defined solely by what can be surgically removed, but by precise biological characterization of the tumor, which determines treatment selection, survival, and quality of life.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Choosing biopsy in these situations reflects <strong>clinical judgment and experience<\/strong>, not therapeutic limitation, and forms the foundation of individualized, evidence-based care.<\/p>\n\n\n\n<h2 id=\"results-of-surgical-treatment\" class=\"wp-block-heading\">Results of Surgical Treatment of Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The outcomes of surgical treatment depend primarily on the <strong>type, malignancy, size, and location<\/strong> of the tumor.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Surgical Mortality:<\/strong> In modern neurosurgery, mortality related directly to the procedure is generally <strong>less than 1%<\/strong>. When it occurs, it is usually due to the complications of pre-existing medical conditions.<\/li>\n\n\n\n<li><strong>Neurological Deficits:<\/strong> The risk of postoperative deficits depends on the tumor&#8217;s size and its proximity to vital brain areas. In most cases, severe neurological deficits occur in <strong>less than 1%<\/strong> of patients. For tumors in complex or &#8222;eloquent&#8220; locations, the risk can increase up to <strong>20%<\/strong>.<\/li>\n\n\n\n<li><strong>Temporary vs. Permanent:<\/strong> It is important to distinguish between <strong>temporary deficits<\/strong>, which may occur due to post-operative brain swelling and resolve as the brain heals, and <strong>permanent deficits<\/strong>, which occur if vital structures are directly affected by the tumor or its removal.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">It is essential that all potential risks associated with the specific type of surgery\u2014whether complete removal or tumor reduction\u2014are <strong>thoroughly explained in advance<\/strong> to the patient and their family. This ensures informed consent and prepares everyone for the recovery and rehabilitation process.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"ph-analysis\" class=\"wp-block-heading\">Pathohistological Analysis (PH Analysis)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The definitive nature of a tumor is determined <strong>4\u20137 days after surgery<\/strong> through a comprehensive analysis of the removed tissue. While traditional <strong>pathohistological analysis (PH analysis)<\/strong> uses special staining techniques and microscopic examination to determine the tumor type and grade, modern diagnostics go much further.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Today, this process is significantly enhanced by:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Immunohistochemistry (IHC):<\/strong> Used to detect specific proteins and markers within the cells to confirm the tumor&#8217;s origin.<\/li>\n\n\n\n<li><strong>Chromosomal and Genetic Analysis:<\/strong> Identifies specific genetic alterations. For example, the presence of an <strong>IDH mutation<\/strong> in astrocytoma or <strong>1p\/19q co-deletion<\/strong> in oligodendroglioma can mean a significantly better prognosis and a different response to therapy than tumors without these markers.<\/li>\n\n\n\n<li><strong>Molecular Grading:<\/strong> We are increasingly identifying specific genes (such as MGMT promoter methylation) that predict how well a tumor will respond to chemotherapy <strong>and help determine the biological aggressiveness of the tumor, beyond what is seen under the microscope.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Modern diagnostics are moving closer to the root cause of malignancy. In the near future, a &#8222;true diagnosis&#8220; will likely transcend simple naming; it will involve identifying the exact <strong>cell of origin<\/strong> and a complete map of <strong>mutated genes<\/strong>. This will allow for <strong>Targeted Therapy<\/strong>, where specific drugs are designed to attack only the mutated proteins or genes, minimizing damage to healthy brain tissue.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Based on this integrated molecular and PH profile, the multidisciplinary board decides on the necessity and type of <strong>adjuvant treatment<\/strong>, such as radiation or personalized chemotherapy.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Radiation Therapy and Chemotherapy for Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Adjuvant treatment methods, which include <strong>radiation therapy and chemotherapy<\/strong>, are used to eliminate remaining tumor cells and prevent recurrence after surgical intervention.<\/p>\n\n\n\n<h3 id=\"radiation-therapy\" class=\"wp-block-heading\"><strong>Radiation Therapy<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"> is most often delivered using sophisticated devices designed to target the tumor with high-energy beams. The goal is to deliver the <strong>highest radiation dose<\/strong> (measured in <strong>Gray\u2014Gy<\/strong>) to the tumor while minimizing exposure to the surrounding healthy brain tissue.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The highest level of precision is achieved through <strong>radiosurgical methods<\/strong> (such as <strong>Gamma Knife, LINAC, and Proton Therapy<\/strong>). These technologies allow for extremely targeted treatment:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>They are highly effective at stopping tumor growth for masses <strong>no larger than 2.5\u20133.5 cm in diameter<\/strong>.<\/li>\n\n\n\n<li>They are ideal for treating <strong>small tumor remnants<\/strong> that were strategically left behind during surgery to protect vital functions.<\/li>\n\n\n\n<li>However, their use is limited if the tumor is located too close to critical structures (like the optic nerves or brainstem) that cannot tolerate high doses of radiation.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"chemotherapy\" class=\"wp-block-heading\">Chemotherapy and Targeted Treatment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Chemotherapy involves the use of specialized drugs (<strong>cytostatics<\/strong>) to kill tumor cells or stop them from dividing. Unlike many other cancers that require intravenous therapy, the primary treatment for many brain tumors (e.g., astrocytoma, GBM) is <strong>Temozolomide <\/strong>(Temodar), an oral chemotherapy agent administered in capsule form.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other Agents:<\/strong> For recurrent tumors or specific types like lymphomas or medulloblastomas, other protocols (such as PCV or Bevacizumab\/Avastin) may be used to target the tumor&#8217;s blood supply or different cellular mechanisms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Temozolomide (Temodar):<\/strong> This is an oral chemotherapy agent (taken in capsule form) that is uniquely effective because it can cross the <strong>blood-brain barrier<\/strong>\u2014the protective shield that prevents many other drugs from entering brain tissue.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The MGMT Connection:<\/strong> The effectiveness of Temodar is closely linked to the <strong>MGMT promoter methylation<\/strong> status. If the MGMT gene is &#8222;silenced&#8220; (methylated), the tumor cells cannot repair the damage caused by Temodar, making the treatment significantly more effective.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Radiochemotherapy:<\/strong> In many aggressive cases, Temodar is administered daily alongside radiation therapy. This combination acts as a &#8222;radio-sensitizer,&#8220; making the radiation more lethal to tumor cells. After radiation is complete, the patient usually continues with maintenance cycles of Temodar.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"alternative-treatment\" class=\"wp-block-heading\">Alternative Treatment Methods in Brain Tumors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Standard medical treatment modalities are not necessarily in contradiction with most <strong>alternative or complementary methods<\/strong>. However, it is essential that patients discuss any such methods with their medical specialists before implementation. The purpose of these discussions is not to discourage patients from exploring alternative therapies, but to prevent situations where such advice might interfere with the efficacy of evidence-based medical treatment. Complementary approaches must not delay evidence-based treatment decisions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In some cases, alternative practitioners may inappropriately suggest modifications to the primary treatment or prescribe supplements that the patient is already receiving in a different form. Furthermore, emphasis is often placed on substances that have not been scientifically proven to be effective or, in some instances, may even be <strong>harmful or counteract<\/strong> the effects of chemotherapy and radiation. Transparency with the neuro-oncology team is vital to ensure that any complementary therapy supports, rather than undermines, the patient&#8217;s recovery.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The specific characteristics of individual types of brain tumors are explained below.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"gliomas\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Gliomas of the Brain<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Gliomas are the most common primary brain tumors, originating from the glial (supportive) cells of the brain. The latest <strong>WHO Classification of Tumours of the Central Nervous System (5th Edition)<\/strong> identifies <strong>more than 100 distinct types and subtypes of gliomas and related tumors<\/strong>, highlighting the immense diversity and complexity of these diseases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">They are broadly categorized into several families, with the most clinical relevance for adults being:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Adult-type Diffuse Gliomas:<\/strong> This is the most frequent group, consisting of <span style=\"text-decoration: underline;\">Astrocytomas<\/span> (IDH-mutant), <span style=\"text-decoration: underline;\">Oligodendrogliomas<\/span> (IDH-mutant and 1p\/19q-codeleted), and <span style=\"text-decoration: underline;\">Glioblastomas<\/span> (IDH-wildtype).<\/li>\n\n\n\n<li><strong>Pediatric-type Gliomas:<\/strong> A distinct group of tumors found in children, further divided into low-grade and high-grade types based on specific genetic mutations.<\/li>\n\n\n\n<li><strong>Ependymal Tumors (Ependymomas):<\/strong> These also belong to the glioma family; they arise from the ependymal cells lining the brain&#8217;s ventricles and the central canal of the spinal cord.<\/li>\n\n\n\n<li><strong>Circumscribed Astrocytic Gliomas:<\/strong> These include types like <span style=\"text-decoration: underline;\">Pilocytic Astrocytoma<\/span>, which grow in a more localized manner compared to diffuse gliomas.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Distribution of Adult-Type Gliomas<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Approximately <strong>90% of all gliomas in adults<\/strong> belong to the group of <strong>diffuse gliomas<\/strong>, which include both lower-grade infiltrative tumors and highly malignant disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Their approximate distribution is:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Oligodendroglioma (IDH-mutant, 1p\/19q-codeleted)<\/strong><br>\u2022 Accounts for <strong>~5\u201310%<\/strong> of adult diffuse gliomas<br>\u2022 Classified as <strong>WHO grade 2 or grade 3<\/strong><br>\u2022 Grade 3 oligodendrogliomas are <strong>malignant tumors<\/strong> requiring combined surgical and adjuvant treatment<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Glioblastoma (IDH-wildtype)<\/strong><br>\u2022 Most frequent and most aggressive adult glioma<br>\u2022 Accounts for <strong>~60\u201370%<\/strong> of adult diffuse gliomas<br>\u2022 Defined as <strong>WHO grade 4 by definition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common \u201eimitators\u201c of glioblastoma include: <a href=\"https:\/\/neurohirurgija.in.rs\/en\/brain-lymphoma\/\">brain lymphoma<\/a>, brain metastases, and abscess<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Astrocytoma (IDH-mutant)<\/strong><br>\u2022 Represents <strong>~15\u201320%<\/strong> of adult diffuse gliomas<br>\u2022 Includes <strong>WHO grade 2, grade 3, and grade 4<\/strong> tumors<br>\u2022 Higher-grade forms (grades 3 and 4) are <strong>malignant<\/strong> and often clinically aggressive<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Gliomas most often, during their growth, <strong>infiltrate<\/strong> surrounding brain structures. They have a high potential to become malignant. According to the degree of malignancy (WHO classification), they are classified into <strong>four grades<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Grade I:<\/strong> A complete cure is very likely after successful surgical removal.<\/li>\n\n\n\n<li><strong>Grade II:<\/strong> These are slower-growing but infiltrative; survival longer than five years is present in <strong>50\u201375%<\/strong> of cases.<\/li>\n\n\n\n<li><strong>Grades III and IV:<\/strong> These represent more aggressive, malignant forms where the survival period is significantly shorter.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Surgical Treatment of Brain Gliomas: Goals and Philosophy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The primary objective of surgery for brain gliomas is the maximum safe resection of the tumor tissue. However, the surgical strategy differs significantly depending on the tumor&#8217;s malignancy and growth pattern.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">1. Surgery for Malignant Gliomas (High-Grade)<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">In malignant cases, the main goal is to remove as much of the <strong>contrast-enhancing portion<\/strong> of the tumor as seen on the MRI.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Extent of Resection:<\/strong> Clinical data suggests that the goal should be a decompression or the removal of more than <strong>76% of the tumor mass<\/strong> to significantly impact survival.<\/li>\n\n\n\n<li><strong>Preserving Quality of Life:<\/strong> The surgeon must carefully avoid causing new neurological deficits. If a radical resection results in a decreased <strong>Karnofsky Performance Status (KPS)<\/strong>\u2014leaving the patient unable to care for themselves\u2014the surgery will not achieve its goal of prolonging life. Functional survival is as important as surgical radicality.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">2. Surgery for Low-Grade (Infiltrative) Astrocytomas<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Because these tumors often do not enhance on contrast, the surgical approach is different:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Signal Abnormality:<\/strong> The goal is to remove everything that appears as an altered signal on the MRI (FLAIR\/T2 sequences).<\/li>\n\n\n\n<li><strong>Surgical Technique:<\/strong> Since there is often no clear boundary (cleavage plane) between the tumor and healthy brain tissue, surgeons use <strong>neuronavigation<\/strong> to follow anatomical landmarks like brain sulci.<\/li>\n\n\n\n<li><strong>Supratotal Resection:<\/strong> Instead of searching for a margin that is hard to detect, the strategy involves safe removing the specific brain segments containing the tumor while monitoring functional integrity.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Adjuvant Treatment of Gliomas<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">After surgery, <strong>radiation therapy<\/strong> is almost always performed, and <strong>chemotherapy<\/strong> is often indicated. The choice of therapy depends on the tumor subtype:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ependymomas:<\/strong> These tumors generally respond more effectively to <strong>radiation therapy<\/strong>, which is often the primary adjuvant treatment to ensure local control.<\/li>\n\n\n\n<li><strong>Oligodendrogliomas:<\/strong> This subtype tends to respond better to <strong>chemotherapy<\/strong>, particularly when specific molecular markers are present, allowing for a more tailored drug-based approach.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Exceptions to Adjuvant Treatment of Gliomas<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In certain scenarios, adjuvant therapy (radiation and chemotherapy) is not required, and the medical team may opt for clinical monitoring. This typically occurs in the following cases:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Completely Removed Low-Grade Gliomas:<\/strong> If a low-grade glioma (WHO Grade 1 or specific Grade 2 cases) has been fully resected (total removal), the risk of immediate recurrence is low enough that further treatment may be deferred in favor of regular MRI follow-ups.<\/li>\n\n\n\n<li><strong>Grade 1 Tumors in Children:<\/strong> Pediatric tumors, such as pilocytic astrocytomas, which have the radiological and biological characteristics of Grade 1 tumors, often have an excellent prognosis. If these are surgically removed or remain stable, adjuvant therapy is avoided to protect the developing brain from the side effects of radiation.<\/li>\n\n\n\n<li><strong>Stable Non-Progressive Lesions:<\/strong> In cases of certain gliozises or very slow-growing benign tumors where the surgical risk outweighs the benefits, and the lesion is not causing neurological deficits, &#8222;active surveillance&#8220; is the preferred strategy.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Scoring System for Malignant Brain Gliomas (The MAS Method)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">To provide a more accurate assessment of illness severity and prognosis, we utilize the <strong>Malignant Astrocytoma Score (MAS)<\/strong>. Developed by the author of this website and published in international medical literature (including <strong>PubMed\/NIH<\/strong> and <strong>ResearchGate<\/strong>), this system allows for a highly individualized approach to treatment planning.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The MAS method calculates a prognosis based on four key clinical factors:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age:<\/strong> The patient&#8217;s age at the time of diagnosis.<\/li>\n\n\n\n<li><strong>Karnofsky Performance Status (KPS):<\/strong> An assessment of the patient&#8217;s functional abilities and quality of life.<\/li>\n\n\n\n<li><strong>Histopathological Grade (PH):<\/strong> The specific malignancy of the tumor cells as determined by a pathologist.<\/li>\n\n\n\n<li><strong>Preoperative Seizures:<\/strong> Whether the patient experienced seizures for at least six months prior to diagnosis, which often indicates a specific biological behavior of the tumor.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">This research has been validated and published in international medical literature. You can access the original study here: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18444219\/\"><strong>The Evaluation of Malignant Astrocytoma Score (MAS) \u2013 PubMed<\/strong>.<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Integration with Modern Molecular Markers<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While the MAS score remains a robust clinical tool, it is most effective when used in conjunction with other modern prognostic parameters. Research and clinical practice show that the MAS score <strong>correlates excellently with molecular markers<\/strong>, particularly the <strong>IDH mutation status<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By combining clinical data from the MAS system with genetic insights (such as IDH status and MGMT methylation), we can achieve a truly comprehensive &#8222;Integrated Diagnosis.&#8220; This synergy allows us to predict the tumor&#8217;s behavior more accurately and customize the therapy to achieve the best possible outcome for the patient.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"meningeomas\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Meningiomas<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Meningiomas are, in most cases, <strong>benign (non-cancerous) tumors<\/strong>. They grow from the <strong>coverings of the brain (meninges)<\/strong>, compressing surrounding parts of the brain, nerves, and blood vessels.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Usually, they are not firmly adherent to surrounding structures so that they can be <strong>completely removed<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Meningiomas can grow in different parts of the skull:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>above the cerebral hemispheres<\/li>\n\n\n\n<li>above the cerebellum<\/li>\n\n\n\n<li>in various regions of the skull base, \u2026<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The symptoms and neurological deficits they cause depend on the <strong>size and location<\/strong> of the meningioma.<br>(A large number of very different clinical presentations is possible.)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For information on tumor development, growth, diagnosis, and treatment, see the introductory section.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is important that the diagnosis is made <strong>while the tumors are still small<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are also <strong>malignant variants<\/strong>, such as <strong>atypical meningioma<\/strong> and <strong>meningosarcoma<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When a tumor inside the skull is diagnosed, there are many indicators suggesting that it is a meningioma. At that point, <strong>experience is required<\/strong> to decide whether the patient should undergo surgery or whether the tumor should only be monitored. <strong>Monitoring<\/strong> is most often chosen when we believe that the tumor does not cause significant pressure on surrounding structures and that it has stopped growing or is growing very slowly. This is particularly the case in <strong>elderly patients<\/strong> or patients who are severely ill due to other diseases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fortunately, with good surgical technique, it is possible to <strong>completely remove the vast majority of meningiomas<\/strong> without major neurological deficits, especially if the tumor is not large and has a favorable location.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Meningiomas: Classification by Location<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Meningiomas are typically named after the specific anatomical site where they originate. Understanding the location is critical because it determines the surgical approach and the potential impact on surrounding neurological structures.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Common locations for meningiomas include:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 <strong>Tentorial Meningioma:<\/strong> Found on the fold of tissue that separates the cerebrum from the cerebellum.<br>\u2022 <strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/olfactory-groove-meningioma\/\">Olfactory Groove Meningioma<\/a>:<\/strong> Located at the anterior base of the skull, above the nose, near the nerves responsible for the sense of smell.<br>\u2022 <strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/sphenoid-wing-meningioma\/\">Sphenoid Wing Meningioma <\/a>(Medial or Lateral):<\/strong> Positioned along the sphenoid bone behind the eyes.<br>\u2022 <strong>Suprasellar \/ Tuberculum Sellae Meningioma:<\/strong> Found near the optic nerves and the pituitary gland.<br>\u2022 <strong>Cavernous Sinus Meningioma:<\/strong> Located in a complex area involving critical veins and cranial nerves behind the eye.<br>\u2022 <strong>Clival and Petroclival Meningioma:<\/strong> Deep-seated tumors located at the base of the skull near the brainstem.<br>\u2022 <strong>Foramen Magnum Meningioma:<\/strong> Situated where the brain joins the spinal cord.<br>\u2022 <strong>Cerebellopontine Angle (CPA) Meningioma:<\/strong> Found in the area between the cerebellum and the pons, often affecting hearing and balance.<br>\u2022<a href=\"https:\/\/neurohirurgija.in.rs\/en\/convexity-meningioma\/\"> <strong>Convexity Meningioma<\/strong><\/a><strong>:<\/strong> Located on the outer surface of the brain, directly under the skull.<br>\u2022 <strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/parasagittal-meningioma\/\">Parasagittal and Sagittal Sinus Meningioma<\/a>:<\/strong> These involve or are adjacent to the large vein (<strong>superior sagittal sinus<\/strong>) that runs along the top of the brain.<br>\u2022 <strong>Posterior Fossa Meningioma:<\/strong> Located in the back of the skull near the cerebellum.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"630\" height=\"570\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Meningeomi.jpg\" alt=\"Common locations of meningiomas\" class=\"wp-image-173\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Meningeomi.jpg 630w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/Meningeomi-300x271.jpg 300w\" sizes=\"auto, (max-width: 630px) 100vw, 630px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: Common locations of meningiomas<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"schwannomas\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Neurinomas (Schwannomas)<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Neurinomas arise from Schwann cells of peripheral nerves.<\/strong> They are most commonly localized on the <strong>hearing and balance nerve<\/strong>. Because of this, they usually begin with <strong>hearing loss and dizziness<\/strong>. This symptom may remain the <strong>only symptom for years<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Later, they may cause:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>facial numbness or pain due to trigeminal nerve compression (secondary trigeminal neuralgia)<\/li>\n\n\n\n<li>facial asymmetry due to facial nerve damage<\/li>\n\n\n\n<li>weakness of the limbs due to pressure on the brainstem<\/li>\n\n\n\n<li>hydrocephalus (accumulation of cerebrospinal fluid in the brain ventricles), \u2026<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">For information on tumor development, growth, diagnosis, and treatment, see the introductory section.<br>It is important that the diagnosis is made <strong>while the tumors are still small<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When a tumor inside the skull is diagnosed, many indicators suggest that it is a neurinoma. <strong>Experience is then required to decide whether the patient should undergo surgery or whether the tumor should only be only monitored.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Clinical Surveillance<\/strong> is most often chosen when we believe that the tumor does not cause significant pressure on surrounding structures (brainstem, nearby nerves, cerebrospinal fluid pathways, \u2026) and that it has stopped growing or is growing very slowly. This is particularly the case in <strong>elderly patients<\/strong> or patients who are severely ill due to other diseases.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Treatment Strategies for Acoustic Neuromas (Vestibular Schwannomas)<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Modern diagnostic tools, particularly high-resolution MRI, now allow acoustic neuromas (vestibular schwannomas) to be detected much earlier than in the past. Today, the majority of these tumors are diagnosed while they are still small\u2014most often below 2.5\u20133 cm in diameter. This shift toward early detection has fundamentally changed treatment strategy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because most newly diagnosed acoustic neuromas are small and do not yet cause significant brainstem compression, <strong>stereotactic radiosurgery<\/strong> (such as Gamma Knife or LINAC-based systems) has become the preferred primary treatment in many cases. The goal of radiosurgery is not immediate tumor removal, but long-term growth control while preserving neurological function, particularly hearing and facial nerve function.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Surgical resection<\/strong> is reserved for selected situations\u2014most commonly for larger tumors, tumors causing significant mass effect on the brainstem, progressive neurological deficits, or when radiosurgery is not appropriate. Modern surgery for acoustic neuromas is highly specialized and <strong>should be performed only in experienced centers with advanced intraoperative neurophysiological monitoring,<\/strong> including continuous monitoring of brainstem function, the facial nerve, and the cochlear (acoustic) nerve. The goal of surgery, when indicated, is maximal safe removal while minimizing permanent neurological deficits.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"pituitary-tumors\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Pituitary Tumors<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">These are tumors that grow from an <strong>endocrine gland located below the center of the brain and above the nose<\/strong> (the pituitary gland).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These tumors may produce excessive amounts of hormones and are therefore usually diagnosed earlier, while still small. Depending on which hormones are produced, the patient may develop:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>High Prolactin levels<\/li>\n\n\n\n<li>Cushing\u2019s disease<\/li>\n\n\n\n<li>acromegaly<\/li>\n\n\n\n<li>or, more rarely, other hormonal disorders<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If the tumor does not produce hormones, it usually grows significantly before causing the first symptoms. Large adenomas most often initially present with <strong>visual disturbances<\/strong> &#8211; loss of peripheral vision (bitemporal hemianopsia)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Later symptoms may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>decreased pituitary hormone production<\/li>\n\n\n\n<li>eye misalignment<\/li>\n\n\n\n<li>double vision<\/li>\n\n\n\n<li>frequent urination<\/li>\n\n\n\n<li>difficulty walking<\/li>\n\n\n\n<li>psychological disturbances<\/li>\n\n\n\n<li>signs of hydrocephalus<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Some smaller tumors (most commonly <strong>prolactinomas<\/strong>) are treated with medications.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most pituitary adenomas today can be removed by <strong>surgery through the nose<\/strong>, without opening the skull. In tumors that grow aggressively, <strong>radiation therapy<\/strong> may also be considered.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most transnasal operations today are performed using an <strong>endoscope<\/strong>&#8211; Endoscopic Endonasal Approach (EEA). With these methods, a large number of skull base tumors can be removed \u201cthrough the nose,\u201d without opening the skull. These tumors often cannot be treated using other surgical methods. To perform these operations, in addition to endoscopy, extensive additional equipment is required, such as navigation systems and neurophysiological monitoring. The significant experience required for successful performance of these operations, as well as all necessary equipment, exists only in the largest centers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The lack of these resources often leads to a practice where only smaller pituitary tumors are successfully removed, while larger and more adherent tumors are not completely excised.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"230\" height=\"190\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2018\/07\/OP-hipofize.jpg\" alt=\"Endoscopic Endonasal Approach (EEA) for pituitary tumor surgery\" class=\"wp-image-204\" style=\"aspect-ratio:1.2106431978943906;width:526px;height:auto\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: Endoscopic Endonasal Approach (EEA) for pituitary tumor surgery<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"brain-metastases\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Brain Metastases<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If a malignant tumor exists elsewhere in the body, malignant cells continuously detach from it and travel through the bloodstream. They may stop in various organs\u2014most commonly the <strong>lungs, liver, and brain<\/strong>\u2014where they multiply and form distant tumors (<strong><a href=\"https:\/\/neurohirurgija.in.rs\/en\/brain-metastases\/\">metastases<\/a><\/strong>).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common brain metastases originate from:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>lung cancer (<strong>about 50% of all brain metastases<\/strong>)<\/li>\n\n\n\n<li>breast cancer<\/li>\n\n\n\n<li>melanoma<\/li>\n\n\n\n<li>kidney cancer<\/li>\n\n\n\n<li>gastrointestinal cancers<\/li>\n\n\n\n<li>prostate cancer, \u2026<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Brain metastases can usually be <strong>completely removed surgically<\/strong>. Their removal should be pursued even when multiple metastases are present, especially when the prognosis for life expectancy and quality of life is favorable (for example, melanoma metastases).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If metastases are multiple, distant from one another, deeply located, and\/or small in diameter, <strong>radiation therapy and\/or chemotherapy<\/strong> may be used.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the patient is in very poor general condition and in the terminal stage of malignant disease, <strong>only symptomatic treatment<\/strong> is indicated.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Personalized Surgical Strategy<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Today, we take a much more aggressive and nuanced approach to surgery. The decision to operate is no longer based solely on the presence of a brain tumor, but on the <strong>overall clinical prognosis<\/strong> provided by the oncologist.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Aggressive Resection:<\/strong> We often pursue the complete surgical removal of metastases even when multiple lesions are present, provided the patient\u2019s systemic disease is under control. For example, <strong>melanoma<\/strong> or <strong>testicular seminoma<\/strong> metastases are often operated on aggressively because these patients can have a favorable long-term survival with modern immunotherapy and surgery.<\/li>\n\n\n\n<li><strong>The &#8222;Hybrid&#8220; Approach:<\/strong> In cases with multiple metastases, we frequently choose to <strong>surgically remove the largest, symptomatic lesions<\/strong> (to relieve pressure) while treating the remaining, smaller, or deeper lesions with <strong>Gamma Knife (stereotactic radiosurgery)<\/strong>.<\/li>\n\n\n\n<li><strong>When Surgery is Avoided:<\/strong> Certain tumors, such as <strong>small cell lung cancer (SCLC)<\/strong>, are highly sensitive to radiation and chemotherapy but tend to be very diffuse. In these cases, surgery is rarely the primary choice unless it is necessary to save the patient&#8217;s life from acute pressure.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prognosis and Quality of Life<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If a patient is in a terminal stage with a very poor general condition, we prioritize <strong>symptomatic treatment<\/strong> to ensure comfort. However, for many, removing a brain metastasis is the key to maintaining the <strong>Karnofsky Performance Status (KPS)<\/strong>, allowing them to continue their systemic cancer treatments (chemotherapy\/immunotherapy).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"680\" height=\"451\" src=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Brain-metastases.jpg\" alt=\"Contrast-enhanced brain MRI showing multiple, well-circumscribed metastatic brain tumors in both hemispheres, appearing as bright lesions with surrounding edema.\" class=\"wp-image-10308\" srcset=\"https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Brain-metastases.jpg 680w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Brain-metastases-300x199.jpg 300w, https:\/\/neurohirurgija.in.rs\/wp-content\/uploads\/2026\/01\/Brain-metastases-18x12.jpg 18w\" sizes=\"auto, (max-width: 680px) 100vw, 680px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Image: Contrast-enhanced brain MRI showing multiple, well-circumscribed metastatic brain tumors in both hemispheres, appearing as bright lesions with surrounding edema.<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 id=\"brain-tumors-in-children\" class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Brain Tumors in Children<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">After leukemia, brain tumors are the <strong>most common tumors in children<\/strong>, accounting for approximately <strong>20%<\/strong> of all childhood cancers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most frequently encountered tumor types in the pediatric population include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Gliomas:<\/strong> Especially astrocytomas of the optic nerve, brainstem, and cerebellum.<\/li>\n\n\n\n<li><strong>Medulloblastomas:<\/strong> And other embryonal tumors (formerly classified as PNET).<\/li>\n\n\n\n<li><strong>Pineal Region Tumors.<\/strong><\/li>\n\n\n\n<li><strong>Craniopharyngiomas.<\/strong><\/li>\n\n\n\n<li><strong>Choroid Plexus Papillomas.<\/strong><\/li>\n\n\n\n<li><strong>Teratomas.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A key distinction in pediatric neuro-oncology is that <strong>tumors of the cerebellum (posterior fossa)<\/strong> are much more common in children than in adults, occurring in <strong>42\u201374% of cases<\/strong>, depending on the child\u2019s age. Due to the critical nature of these locations, early diagnosis and specialized microsurgical techniques are essential for a favorable long-term outcome. In contrast to the pediatric population, cerebellar tumors in adults are considered metastatic until proven otherwise.<\/p>\n\n\n\n<div style=\"border: 1px solid #ccc; border-radius: 12px; padding: 20px; margin-top: 40px; box-shadow: 0 2px 8px rgba(0,0,0,0.1); background-color: #f9f9f9;\">\n  <h2 id=\"request-brain-tumor-second-opinion\" style=\"margin-top: 0; color: #004466;\">\n    Request a Neurosurgery Second Opinion for Brain Tumors \u2014 Standard 24-Hour Review or Priority Option (Usually Within 3 Hours)\n  <\/h2>\n\n  <p>\n    A diagnosis of a brain tumor often raises complex and unsettling questions \u2014 about tumor type, operability, prognosis,\n    and whether the proposed treatment strategy is truly optimal. This is especially true when opinions differ,\n    surgery is described as \u201chigh risk,\u201d or molecular and pathological findings are difficult to interpret.\n    <br><br>\n    An independent neurosurgical second opinion helps place imaging (MRI\/CT), pathology, and molecular markers\n    into a clear clinical context. We review whether the diagnosis and treatment plan follow modern neuro-oncology principles,\n    and explain what options realistically exist \u2014 including surgery, radiation, chemotherapy, active surveillance,\n    or combined (hybrid) approaches.\n  <\/p>\n\n  <ul style=\"padding-left: 0; margin-bottom: 20px; list-style: none;\">\n    <li style=\"position: relative; padding-left: 28px; margin: 8px 0;\">\n      <span style=\"position:absolute; left:0; top:0;\">\u2714<\/span>\n      Send a short message describing the brain tumor diagnosis and your main questions\n    <\/li>\n    <li style=\"position: relative; padding-left: 28px; margin: 8px 0;\">\n      <span style=\"position:absolute; left:0; top:0;\">\u2714<\/span>\n      You will receive a reply within 24 hours confirming if and how we can help \u2014 including consultation cost and timing\n    <\/li>\n    <li style=\"position: relative; padding-left: 28px; margin: 8px 0;\">\n      <span style=\"position:absolute; left:0; top:0;\">\u2714<\/span>\n      <strong>In urgent or time-sensitive cases<\/strong> (rapid deterioration, upcoming surgery, unclear operability),\n      a priority consultation can usually be arranged within a few hours.\n      <strong>If needed, write PRIORITY in your initial message.<\/strong>\n    <\/li>\n    <li style=\"position: relative; padding-left: 28px; margin: 8px 0;\">\n      <span style=\"position:absolute; left:0; top:0;\">\u2714<\/span>\n      After the initial reply, you may send relevant documentation (MRI\/CT images, pathology reports, molecular findings)\n    <\/li>\n    <li style=\"position: relative; padding-left: 28px; margin: 8px 0;\">\n      <span style=\"position:absolute; left:0; top:0;\">\u2714<\/span>\n      During the video consultation, we explain the findings in clear language and answer all practical questions\n    <\/li>\n  <\/ul>\n\n  <div style=\"margin-bottom: 15px;\">\n    <div style=\"font-weight: bold;\">\n      Consultation fees typically range from $180\u2013250, depending on case complexity.\n    <\/div>\n    <div style=\"font-weight: bold;\">\n      Secure payment by credit card, PayPal invoice (USD), or bank transfer.\n    <\/div>\n    <div style=\"font-size: 14px; color: #333; margin-top: 4px;\">\n      This fee range is consistent with international specialist telehealth second opinions in neurosurgery.\n      Families and patients often seek a second opinion to clarify diagnosis, confirm treatment strategy,\n      or better understand risks, benefits, and realistic outcomes.\n    <\/div>\n  <\/div>\n\n  <div style=\"display: flex; gap: 10px; flex-wrap: wrap;\">\n    <a href=\"https:\/\/wa.me\/381628534555\" style=\"background-color: #25D366; color: white; padding: 10px 16px; border-radius: 8px; text-decoration: none;\">\n      \ud83d\udcf1 WhatsApp Message\n    <\/a>\n    <a href=\"mailto:zkoja@yahoo.com\" style=\"background-color: #0073aa; color: white; padding: 10px 16px; border-radius: 8px; text-decoration: none;\">\n      \u2709 Email Us\n    <\/a>\n    <a href=\"https:\/\/m.me\/zeljko.kojadinovic.3\" style=\"background-color: #1877f2; color: white; padding: 10px 16px; border-radius: 8px; text-decoration: none;\">\n      \ud83d\udcac Messenger Chat\n    <\/a>\n  <\/div>\n<\/div>\n\n\n\n<h2 id=\"faq-brain-tumors\" style=\"margin-top: 14px;\">Frequently Asked Questions About Brain Tumors<\/h2>\n\n<div class=\"faq-accordion\" style=\"margin:32px 0;\">\n  <style>\n    .faq-accordion details {\n      border: 1px solid #e3e8ef; border-radius: 10px; background:#f8fafc;\n      padding: 12px 16px; margin: 10px 0;\n    }\n    .faq-accordion summary {\n      list-style: none; cursor: pointer; font-weight: 700; color:#0b3a5e;\n    }\n    .faq-accordion summary::-webkit-details-marker { display: none; }\n    .faq-accordion summary::after {\n      content: \"\uff0b\"; float: right; font-weight: 700; color:#0b3a5e;\n    }\n    .faq-accordion details[open] summary::after { content: \"\u2212\"; }\n    .faq-accordion .answer { margin-top: 10px; color:#0f172a; line-height:1.6; }\n  <\/style>\n\n  <details>\n    <summary><strong>What is a brain tumor?<\/strong><\/summary>\n    <div class=\"answer\">\n      A brain tumor is an abnormal growth of cells inside the skull. Some tumors arise from brain tissue or surrounding structures (primary tumors),\n      while others spread to the brain from cancers elsewhere in the body (secondary tumors, also called brain metastases).\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is the difference between a primary brain tumor and a brain metastasis?<\/strong><\/summary>\n    <div class=\"answer\">\n      Primary brain tumors start inside the brain or its coverings (for example, gliomas or meningiomas). Brain metastases are tumors that originate in another organ\n      (such as lung, breast, melanoma, kidney) and then spread to the brain through the bloodstream. In adults, metastases are very common and must always be considered.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Are most brain tumors cancer?<\/strong><\/summary>\n    <div class=\"answer\">\n      No. Many intracranial tumors are benign (non-cancerous), such as most meningiomas, pituitary adenomas, and schwannomas.\n      However, some tumors are malignant (cancerous) and may infiltrate brain tissue (for example, many diffuse gliomas).\n      Even benign tumors can be dangerous if they compress critical brain structures or cause swelling.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What are the most common brain tumor types in adults?<\/strong><\/summary>\n    <div class=\"answer\">\n      In everyday clinical practice, the most common adult intracranial tumor groups include meningiomas, gliomas (including glioblastoma),\n      pituitary adenomas, schwannomas (vestibular schwannomas\/acoustic neuromas), and brain metastases.\n      The exact frequency varies between registries and depends on whether benign tumors are included in the statistics.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What symptoms can a brain tumor cause?<\/strong><\/summary>\n    <div class=\"answer\">\n      Symptoms depend on tumor size, location, swelling (edema), and whether there is bleeding or hydrocephalus.\n      Common symptoms include headaches, seizures, progressive weakness or numbness, speech or vision problems, balance issues,\n      personality or cognitive changes, and cranial nerve symptoms (hearing loss, double vision, facial numbness).\n      Some slow-growing tumors may cause very subtle symptoms for months or years.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Does a normal neurological exam rule out a brain tumor?<\/strong><\/summary>\n    <div class=\"answer\">\n      No. A patient can have a normal neurological exam and still have a tumor, especially if the lesion is small, slow-growing,\n      or located in a region that does not produce early focal deficits. If symptoms are concerning (new seizures, progressive deficits,\n      unexplained cognitive changes), imaging is still needed.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is the best test to diagnose a brain tumor?<\/strong><\/summary>\n    <div class=\"answer\">\n      MRI of the brain is the gold standard. It shows tumor anatomy, edema, mass effect, and contrast enhancement patterns.\n      CT is useful in emergencies (for example, acute bleeding, hydrocephalus, severe mass effect) but MRI provides the most complete evaluation.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What does \u201ccontrast enhancement\u201d mean on MRI?<\/strong><\/summary>\n    <div class=\"answer\">\n      Contrast enhancement means that a region becomes brighter after gadolinium contrast is given.\n      It often reflects abnormal blood-brain barrier and tumor vascularity. Enhancement can suggest higher-grade tumor activity,\n      but it is not a perfect marker of malignancy\u2014some aggressive tumors may enhance minimally, and some benign tumors may enhance strongly.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is brain edema and why does it matter?<\/strong><\/summary>\n    <div class=\"answer\">\n      Brain edema is swelling around a tumor caused by fluid leakage into surrounding tissue.\n      It increases intracranial pressure and can worsen symptoms quickly (headache, drowsiness, neurological deficits).\n      Steroids such as dexamethasone are often used to reduce tumor-related edema and stabilize the patient before definitive treatment.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What does \u201cmidline shift\u201d mean on CT or MRI?<\/strong><\/summary>\n    <div class=\"answer\">\n      Midline shift means the tumor and swelling have pushed the brain away from its normal central position.\n      Larger shift suggests higher intracranial pressure and higher risk of herniation, and it often indicates the need for urgent neurosurgical assessment.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>When is surgery necessary for a brain tumor?<\/strong><\/summary>\n    <div class=\"answer\">\n      Surgery is considered when a tumor causes significant mass effect, progressive neurological deficits, seizures that are difficult to control,\n      uncertain diagnosis requiring tissue confirmation, or when maximal safe removal is expected to improve survival or quality of life.\n      In some situations (small stable tumors, high surgical risk, or tumors in critical locations), active surveillance or biopsy may be recommended instead.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Is complete removal always possible?<\/strong><\/summary>\n    <div class=\"answer\">\n      Not always. Many tumors (especially diffuse gliomas) infiltrate normal brain tissue and have no clear boundary,\n      which makes total removal impossible without causing major neurological injury. In these cases, the goal is \u201cmaximum safe resection\u201d\n      or decompression, followed by guideline-based adjuvant therapy.\n      In contrast, many benign tumors or metastases may have clearer margins and can often be removed completely.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is a stereotactic biopsy and when is it used?<\/strong><\/summary>\n    <div class=\"answer\">\n      A stereotactic biopsy is a minimally invasive procedure that obtains a small tissue sample using a precise navigation system.\n      It is used when the tumor is deep, located in a high-risk area, or when removal would be too dangerous.\n      The goal is to obtain a diagnosis so that radiation, chemotherapy, or other targeted treatments can be planned.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is the role of modern technologies like neuronavigation, 5-ALA, and awake craniotomy?<\/strong><\/summary>\n    <div class=\"answer\">\n      Neuronavigation helps the surgeon reach deep lesions accurately using MRI\/CT-based guidance. 5-ALA fluorescence can highlight tumor tissue\n      under the microscope in selected gliomas, improving the extent of resection. Awake craniotomy is used for tumors near speech or motor areas,\n      allowing real-time functional testing to maximize safe tumor removal while protecting critical function.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>How is the final tumor diagnosis confirmed?<\/strong><\/summary>\n    <div class=\"answer\">\n      The definitive diagnosis comes from tissue analysis after biopsy or surgery. Modern pathology integrates classic histology with immunohistochemistry (IHC)\n      and molecular\/genetic markers (for example, IDH mutation, 1p\/19q co-deletion, MGMT promoter methylation). This \u201cintegrated diagnosis\u201d strongly influences\n      prognosis and treatment decisions.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>What is MGMT methylation and why is it important in glioblastoma?<\/strong><\/summary>\n    <div class=\"answer\">\n      MGMT is a DNA-repair gene. If the MGMT promoter is methylated (\u201csilenced\u201d), tumor cells are less able to repair chemotherapy-induced DNA damage.\n      In practice, MGMT promoter methylation is associated with a better response to temozolomide (Temodar) and improved outcomes in many patients.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>When are radiation therapy and chemotherapy used?<\/strong><\/summary>\n    <div class=\"answer\">\n      Radiation and\/or chemotherapy are used when microscopic tumor cells may remain after surgery, when tumors are malignant,\n      or when surgery is not possible. For many aggressive gliomas, combined radiochemotherapy (radiation with temozolomide)\n      is a standard approach. For selected benign remnants, stereotactic radiosurgery (Gamma Knife\/LINAC) may control growth without open surgery.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Can brain metastases be treated surgically?<\/strong><\/summary>\n    <div class=\"answer\">\n      Yes. Many brain metastases are well-circumscribed and can often be removed completely, especially if one lesion is dominant or causing mass effect.\n      A common modern strategy is a \u201chybrid approach\u201d: removing the largest symptomatic metastasis and treating smaller\/deeper lesions with stereotactic radiosurgery.\n      The decision depends on systemic cancer control, expected survival, and functional status (KPS).\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Is it safe to use alternative or \u201cnatural\u201d treatments instead of standard therapy?<\/strong><\/summary>\n    <div class=\"answer\">\n      Complementary approaches may help with well-being, but they must not delay evidence-based treatment.\n      Some supplements can interfere with chemotherapy, radiation, seizure medications, or blood clot prevention.\n      Any alternative therapy should be discussed with the neuro-oncology team to avoid harmful interactions and lost time.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>When should families seek an urgent neurosurgical second opinion?<\/strong><\/summary>\n    <div class=\"answer\">\n      Consider an urgent second opinion when: the diagnosis is unclear; imaging shows significant edema or midline shift;\n      neurological status is worsening; surgery is labeled \u201ctoo risky\u201d without clear explanation; there are conflicting recommendations;\n      or the family needs a structured plan (what is urgent now, what can wait, and which treatment options exist).\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary><strong>Can we get a telehealth neurosurgery second opinion for brain tumors, including priority review?<\/strong><\/summary>\n    <div class=\"answer\">\n      Yes. Families can request a telehealth neurosurgery second opinion for brain tumors.\n      Priority review is available in urgent cases.\n      <a href=\"https:\/\/neurohirurgija.in.rs\/en\/second-opinion-in-neurosurgery-trusted-insight\/\" target=\"_blank\" rel=\"noopener\" style=\"color:#005c99; text-decoration:underline;\">\n        Learn more about our neurosurgery second opinion\n      <\/a>.\n    <\/div>\n  <\/details>\n\n<\/div>\n\n\n\n<h2 id=\"patient-friendly-sources\" style=\"margin-top: 14px;\">\n  Patient-Friendly Resources on Brain Tumors (Trusted Institutions)\n<\/h2>\n\n<p>\n  The links below are written for patients and families in clear, non-technical language.\n  I manually re-checked the URLs while preparing this list.\n<\/p>\n\n<ul style=\"margin: 12px 0 0 18px; line-height: 1.65;\">\n\n  <li>\n    <a href=\"https:\/\/www.cancer.gov\/types\/brain\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      National Cancer Institute (NCI) \u2014 Brain Tumors (Patient Version)\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 reliable overview + links to tumor types and treatments.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.cancer.gov\/types\/brain\/patient\/adult-brain-treatment-pdq\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      NCI PDQ \u2014 Adult Central Nervous System Tumors Treatment\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 more detailed (still patient-facing) treatment pathways.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/brain-tumor\/symptoms-causes\/syc-20350084\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      Mayo Clinic \u2014 Brain tumor (Symptoms &#038; Causes)\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 practical symptom explanations and \u201cwhat it means.\u201d<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/brain-tumor\/diagnosis-treatment\/drc-20350088\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      Mayo Clinic \u2014 Brain tumor (Diagnosis &#038; Treatment)\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 MRI\/biopsy basics and major treatment options.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.nhs.uk\/conditions\/brain-tumours\/\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      NHS \u2014 Brain tumours (overview)\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 plain-language overview + when to seek help.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/brain-tumours\/symptoms\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      Cancer Research UK \u2014 Brain tumour symptoms\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 symptom patterns and \u201craised intracranial pressure\u201d explained.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.macmillan.org.uk\/cancer-information-and-support\/brain-tumour\/signs-and-symptoms-of-a-brain-tumour\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      Macmillan Cancer Support \u2014 Signs &#038; symptoms of a brain tumour\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 patient support + symptom guidance and next steps.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.abta.org\/\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      American Brain Tumor Association (ABTA) \u2014 Educational Resources\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 excellent patient education + caregiver materials.<\/span>\n  <\/li>\n\n  <li>\n    <a href=\"https:\/\/www.thebraintumourcharity.org\/brain-tumour-signs-symptoms\/brain-tumour-location-symptoms\/\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline;\">\n      The Brain Tumour Charity \u2014 Symptoms by tumor location\n    <\/a>\n    <span style=\"color:#475569;\">\u2014 easy \u201cwhere in the brain \u2192 what symptoms\u201d explanation.<\/span>\n  <\/li>\n\n<\/ul>\n\n<h3 id=\"mas-score\" style=\"margin-top: 18px;\">\n  Scientific Resource: MAS Scoring System (Malignant Astrocytomas)\n<\/h3>\n\n<p style=\"margin: 8px 0 0 0; line-height: 1.65;\">\n  For readers who want a more technical (research) reference, here is the original publication of the\n  <strong>Malignant Astrocytoma Score (MAS)<\/strong>:\n  <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18444219\/\" target=\"_blank\" rel=\"noopener\" style=\"text-decoration: underline; font-weight: 700;\">\n    PubMed: A new scoring system for malignant astrocytomas (MAS)\n  <\/a>.\n<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Author: Dr. Zeljko Kojadinovic, MD, PhD \u2014 Neurosurgeon and Pain Management Specialist Specialized Experience: 30 years of clinical expertise in neurosurgery. Last medically reviewed: January 6, 2026 Who This Brain Tumors Page Is For This brain tumors overview page is designed primarily for patients who have been diagnosed with a brain tumor (or told they [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_titles_title":"Brain Tumors: Types, Symptoms, MRI Diagnosis & Treatment","_seopress_titles_desc":"Expert overview of brain tumors: symptoms, MRI diagnosis, pathology, surgery, radiation and chemotherapy. 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