Brain, Spine and Nervous System Tumors

Scripps neuro-oncology physicians are specially trained in nervous system tumors, including both primary tumors and those that have spread (metastasized) to the brain, spinal cord or nerves. Our neuro-oncologists oversee testing, treatment and monitor patients with nervous system tumors into survivorship. We also specialize in managing neurologic symptoms associated with cancer treatments and nervous system tumors.

Scripps neurosurgical oncologists perform surgery to remove tumors that affect the brain, skull base and central nervous system. Many Scripps surgeons are experts in minimally invasive surgical techniques, including laparoscopic and robotic-assisted surgery. Our neurosurgeons are also trained in detailed mapping of the brain to ensure a precise balance between removing the tumor and protecting healthy brain tissue.

CNS radiation oncologists are physicians who specialize in using radiation therapy to treat, prevent or delay the recurrence of central nervous system (CNS) tumors.

Glioma is the general term for tumors that arise from the support cells of the brain known as glial cells. Normally, glial cells hold nerve cells in place so they can work correctly and support brain function. There are many types of glial cells, and many types of gliomas.

Astrocytoma

A brain tumor that develops from astrocytes. In recent years, mutations in these tumors have made precise diagnostics critical to accurately determine the type of tumor and the grade. There are multiple types of astrocytomas.

Glioblastoma (grade 4)

The most common malignant brain tumor in adults. Glioblastoma, also known as GBM, grows quickly and requires urgent diagnosis and treatment. GBM often develops in the cerebral hemispheres but may occur almost anywhere in the brain or even in the spinal cord. 

Oligodendroglioma (grade 2, 3)

A brain tumor arising from oligodendrocytes, which are cells that normally wrap around and provide support to nerve fibers in the brain. There are key DNA changes in these tumors that make them more susceptible to treatment. 

IDH mutated-astrocytoma (grade 2,3,4)

These tumors may initially grow slowly with small clusters of tumor cells that grow into nearby healthy brain tissue. With time, these grow faster and can injure healthy brain cells. Molecular evaluation of these tumors is critical for diagnosis and effective multimodal treatment plans.

Brainstem glioma (grade 1,2,3,4)

A general term for many gliomas located in the brainstem. Some of these are slow growing and other progress more rapidly.

Diffuse midline glioma, H3K27M altered 

Originates in the deep structures of the brain or in the spinal cord. Molecular evaluation of these tumors is critical for diagnosis and effective multimodal treatment plans. 

Pilocytic astrocytoma (grade 1)

Considered a benign type of astrocytoma. These slow-growing tumors usually occur in children or young adults but can be found in adults of any age. Molecular evaluation of these tumors is critical for diagnosis and effective multimodal treatment plans. 

Pleomorphic xanthoastrocytoma (grade 2-3)

A rare brain tumor that primarily affects children and young adults. This type of tumor can be slower growing or faster growing which guides the grading. Molecular evaluation of these tumors is critical for diagnosis and effective multimodal treatment plans.

A group of tumors that begin in the pituitary, a pea-sized gland in the brain that secretes and regulates hormones controlling many important body functions. Most pituitary tumors, classified as pituitary neuroendocrine tumor (PitNET - previously known as pituitary adenomas), are benign and slow-growing. They can however press on critical brain structures and require treatment. Less than 1% of pituitary tumors are malignant and can spread to other parts of the body; these are called pituitary carcinomas.

Learn more about a patient's pituitary tumor treatment at Scripps.

A rare non-Hodgkin lymphoma in which malignant cells from lymph tissue form in the brain and/or spinal cord. This can occur with or without lymphoma in the body.

Rare tumors that develop in the cells that line the fluid-producing structures of the brain called the choroid plexus. These tumors include choroid plexus papilloma, which is typically a benign tumor, as well as choroid plexus carcinoma, which is a malignant lesion that can spread to other parts of the brain through cerebrospinal fluid.

A type of brain and spinal cord tumor that develops from ependymal cells, which line the fluid-filled cavities (called ventricles) in the brain and the spinal cord. These can spread in the spinal fluid and require molecular evaluation for diagnosis and effective multimodal treatment plans.

Benign tumors that grow slowly but may cause neurologic symptoms based on location. These may be associated with a genetic syndrome, Von Hippel Lindau, which requires comprehensive surveillance. 

A malignant tumor that starts in the cerebellum, which controls balance, coordination, and other complex functions. This tumor can grow rapidly and spread to other parts of the brain or spinal cord.

A tumor that develops in the meninges, the protective membrane layers surrounding the brain and spinal cord. Most meningiomas grow slowly and do not spread but may regrow after treatment and require monitoring. Some meningiomas are malignant and faster growing. 

A group of rare tumors that affect the brain and spinal cord. Neuronal tumors are composed of abnormal neurons. Mixed neuronal-glial tumors have abnormal neuron cells along with glial cells. 

Rare tumors that start in the pineal gland, an endocrine gland that secretes hormones that regulate sleep patterns and other functions. These tumors primarily occur most commonly in children and younger adults. 

These tumors begin in the brain or spinal cord and may spread in spinal fluid as well. Molecular evaluation of these tumors is critical for diagnosis and effective multimodal treatment plans. 

Neurofibroma

A slow-growing tumor that can occur on any of the peripheral nerves outside of the brain and spinal cord that are ensheathed by Schwann cells, which normally wrap around motor and sensory nerves. Neurofibroma symptoms can vary greatly, depending on the size, location, and subtype of tumor. Many neurofibromas cause no symptoms. Others, even though these tumors are classified as benign, may cause pain, numbness, or other neurologic symptoms.

Optic gliomas

A group of gliomas that are usually slow-growing, benign tumors that affect one or both optic nerves that transmit visual information from the eye to the brain. Rarely, these can be faster-growing tumors that are considered malignant. 

Schwannoma

A benign, slow-growing tumor that can occur on any of the peripheral nerves outside of the brain and spinal cord that are ensheathed by Schwann cells, which normally wrap around motor and sensory nerves. This includes the cranial nerves, which transmit information between the brain and parts of the head and neck. Vestibular schwannomas (or acoustic neuromas) is a type of schwannomas on cranial nerve VIII (also called the vestibulocochlear nerve) which transmits sound and balance information from the inner ear to the brain.

Acoustic neuroma (or vestibular schwannoma)

A type of schwannomas on cranial nerve VIII (also called the vestibulocochlear nerve) which transmits sound and balance information from the inner ear to the brain. These may be associated with a genetic syndrome. 

Chondrosarcoma

A rare type of malignant bone tumor usually found along the bony structure behind the eyes or at the base of the skull.

Chordoma

A rare, malignant bone cancer that develops at the base of the skull or in the spine. Chordoma tumor cells begin in the notochord, a structure in the central nervous system of embryos. It usually disappears before birth, but sometimes notochord cells can remain; in patients with chordoma, these cells become abnormal and begin multiplying to form a tumor. Chordomas grow slowly but have a tendency to recur after treatment and can spread (or metastasize) through the bloodstream to other parts of the body. 

Craniopharyngioma

A benign tumor at the base of the brain that starts near the pituitary gland. Adamantinomatous craniopharyngioma mainly occurs in children, while papillary craniopharyngioma mainly occurs in adults. Both are benign tumors but, as they grow, they may put pressure on nearby brain regions and cause symptoms. Molecular evaluation of these tumors is critical for diagnosis and effectively developing multimodal treatments. 

Dermoid and epidermoid tumors (or cysts)

Slow-growing masses of oil and skin cells most commonly found in the head, neck and face. They are usually benign but if they press against a nerve, such as the optic nerve, they can cause symptoms. 

Germinoma

Rare tumors that start from germ cells. Normally, germ cells become eggs or sperm after migrating to the ovaries or testes during fetal development. Germinomas occur when these germ cells fail to migrate to the proper location and continue dividing in another part of the body. Germ cell tumors can be found in various parts of the body, but germinomas occur within the brain, primarily in children and adolescents but can be diagnosed in adults.

Cancer spreading (metastasizing) from another part of the body is the most common cause of a brain tumor. Metastatic brain tumors do not start in the brain but have spread to the area from other parts of the body. Treatment options for brain metastasis are rapidly evolving and partnerships between medical oncologists, neuro-oncologists, radiation oncologist and neurosurgeons are critical for optimal management.

Cancer that spreads (metastasizes) from another part of the body to the spine is the most common cause of spine tumors in the bones surrounding the spinal cord. At times, cancer can spread to the spinal cord. Spinal cancers require multidisciplinary care from a team of oncologists to relieve symptoms and maintain quality of life.

Cancer from the body can spread to the covering of the brain or spinal cord, or to the cerebrospinal fluid (CSF) surrounding the brain and spinal cord. This is a serious complication of cancer and requires close multidisciplinary care with medical oncologists, neuro-oncologists and radiation oncologists. Treatment and monitoring of leptomeningeal metastasis is rapidly advancing and Scripps is at the forefront of cancer treatments to improve survival and quality of life of patients with leptomeningeal metastasis.

• MRI brain 3T and 1.5T
• MRI - perfusion
• MRI - spectroscopy 
• MRI - diffusion tensor imaging and tractography
• MRI angiography 
• CT 
• CT angiography
• Cerebral angiogram 
• Nuclear imaging

Extended evaluation of tumor genetics may include next-generation sequencing and methylation array testing as well as histologic pathologic evaluation. This testing can enable us to identify specific, targetable treatments for tumors.

• Intraoperative tumor guided techniques (ex: 5-ALA, fluorescein, ICG) 
• Advanced Neuromonitoring techniques for patient safety 
• Awake and asleep monitoring 
• Brainstem monitoring motor and sensory cranial nerves spinal cord mapping and monitoring 
• Spinal cord functional mapping

• Cerebral spinal fluid (CSF) sampling with advanced testing including molecular markers

Detailed neurologic and cognitive testing to evaluate areas of the brain that may be impacted by tumors or treatments, this testing can also help guide neurosurgical and other treatment planning.

Scripps neurosurgeons may perform maximal safe tumor resections. That means our surgeons consider both the amount of tumor to be removed and neurologic functioning. Neurosurgery at Scripps involves a tailored approach to the patient and the type of tumor. Surgical planning may be in consultation with multiple specialists including neuropsychologists, neuro radiologists, intra neuro-operative monitoring, other surgeons, radiation oncologists, medical oncologists and neuro-oncologists. 

Some specialized neurosurgical techniques at Scripps include:

• Minimally invasive brain surgery options
• Keyhole approaches
• Endoscopic skull base and pituitary surgery
• Endoscopic intraventricular tumor surgery
• Trans orbital surgical approach 

• Intracranial tumor advanced neurosurgical approaches
• Functional brain mapping
• Skull base surgery
• Awake craniotomy
• Complex reconstructive surgery

• Spine tumor (primary and metastatic) specialization
• Spinal cord functional mapping for both intramedullary and extra medullary intradural spine tumors
• Spinal bone tumor resection
• Spine reconstruction 

• Advanced safety monitoring
• Advanced neuromonitoring techniques for patient safety
• Awake and asleep monitoring 
• Brainstem monitoring motor and sensory cranial nerves spinal cord mapping and monitoring
• Spinal cord functional mapping

Radiation therapy may be used alone or after surgery to treat many types of brain and spinal cord cancer. Scripps offers several types of highly targeted radiation treatments, including stereotactic radiosurgery, and stereotactic body radiation therapy (SBRT) for tumors such as acoustic neuroma tumors.

• Stereotactic radiosurgery 
• Stereotactic body radiation therapy (SBRT)
• IMRT 
• Whole brain radiation (+/- hippocampal avoidance)
• Craniospinal radiation 
• Spinal radiation

Chemotherapy for brain and central nervous system tumors is most often used with other treatments, such as surgery and radiation therapy. Several chemotherapy drugs are FDA-approved for use with brain tumors.

FDA-approved drugs, such as bevacizumab, vorasidenib, tovorafenib and beltizufan may be used in combination with chemotherapy or alone to treat patients with brain tumors. Scripps Cancer Center physicians provide the best possible course of treatment for patients who may benefit from targeted therapies for tumors in the brain or central nervous system.

Also called biologic therapy, immunotherapy is designed to use the body’s own immune system to fight cancer.

Some cancer patients may be appropriate for Scripps’ brain injury day treatment program. The program provides comprehensive rehabilitation evaluations for patients who have had an acquired brain injury or illness. The evaluations can assist patients, their families and their medical team in determining the appropriate rehabilitation. Patients may work individually or in groups with a comprehensive team that includes physical therapists, occupational therapists, speech therapists, an audiologist and social services.

Some tumor treatment plans may involve clinical trials. Talk to your physician about whether a clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.