Synopsis
Explain how a neuro-oncology multidisciplinary team selects tissue acquisition, maximal safe resection, radiotherapy and supportive care according to tumour biology, anatomy, function and patient goals.
- Biopsy establishes histological and molecular diagnosis when resection is unsafe or inappropriate; resection can add decompression and cytoreduction but must remain maximal safe, not maximal at any neurological cost.
- Treatment selection is an MDT decision integrating current WHO diagnosis, molecular markers, tumour location and extent, symptoms, performance, comorbidity, prior therapy, prognosis and informed patient priorities.
- Radiotherapy may be focal, stereotactic, fractionated or whole-brain depending on entity and target; its potential local control is balanced against acute toxicity and late cognitive, vascular, endocrine, cranial-nerve and radionecrosis risks.
Key red flags
New decline in consciousness, pupil asymmetry, posturing, repeated vomiting or rapid focal progression indicates mass effect, haemorrhage or hydrocephalus.
New fever, wound leakage, meningism or systemic instability after biopsy or resection suggests infection or CSF leak and needs urgent assessment.
New or worsening focal deficit after surgery may reflect haemorrhage, infarction, oedema or seizure rather than an expected recovery course.
Progressive dysphagia, aspiration, immobility or cognitive loss demands early supportive and rehabilitation intervention alongside oncological care.
A radiological lesion near eloquent cortex, brainstem, optic pathways or major vessels requires function-preserving planning; “maximal” resection never means sacrificing foreseeable major function.
A patient whose disease, frailty or preferences make disease-directed treatment more burdensome than beneficial still needs active supportive and palliative care, not abandonment.
New deficit, seizure, reduced consciousness, severe headache or vomiting after cranial surgery needs prompt examination and imaging for haemorrhage, infarction, oedema, hydrocephalus or infection.
Investigation priorities
Define lesion extent, eloquent relationships, target volumes and areas most likely to yield diagnostic tissue.
Management branches
MRI shows a new intrinsic lesion and the patient is stable enough for planned specialist treatment.
- Refer at radiological diagnosis to the neuro-oncology MDT, begin supportive and rehabilitation needs assessment alongside active treatment, and define the immediate goals, neurological baseline, performance, anatomy, differential and whether emergency pressure control is needed.
- Choose maximal safe resection when decompression, cytoreduction and adequate tissue justify the functional risk; choose biopsy when resection is unsafe or inappropriate, and reserve monitoring without tissue for carefully selected lesions with typical very-low-grade features.