What it is
"Brain tumor" is a broad category that covers many distinct diagnoses — meningiomas, gliomas, metastatic lesions, pituitary tumors, vestibular schwannomas, and others — each with different behaviors and treatment pathways. Some grow slowly and can be safely watched. Some are aggressive and need prompt treatment. Some are best handled with radiation, some with surgery, some with both.
The work of evaluation is to figure out which diagnosis we're dealing with and what the most appropriate plan looks like for this specific patient.
How we approach it
My fellowship training in neurosurgical oncology at the University of Colorado, together with earlier bench research at Roswell Park Comprehensive Cancer Center in glioma immunotherapy, shaped how I think about brain tumor care. The emphasis is on:
- Accurate diagnosis first. Advanced imaging, and in many cases tissue sampling, before committing to a treatment path.
- Multidisciplinary planning. Many tumors do best with coordinated input from medical oncology, radiation oncology, neuro-pathology, and — when relevant — medical genetics.
- Technique matched to the tumor. Some tumors are best approached with awake craniotomy to preserve speech and motor function; some with endonasal transsphenoidal surgery for pituitary lesions; some with stereotactic radiosurgery alone.
When surgery is considered
Surgery is considered when a diagnosis needs to be established, when a tumor is causing symptoms that can be relieved, or when surgical removal meaningfully improves the path forward. For some diagnoses, surgery isn't the right answer — radiation or systemic therapy may be more appropriate, and we'll say so.