Neurosurgical Oncology

Following the diagnosis of a brain or spinal cord tumor, you will be introduced to a diverse team of specialists, each with a unique understanding of your or your loved one’s disease. One member of this team will be a neurosurgeon specialized in the treatment of brain and/or skull base tumors (also referred to as neurosurgical oncologist.)

In this post, we will explain how a neurosurgical oncologist will contribute to your care and provide information about how to choose the right treatment option for you. In addition, we will briefly discuss the other members of your care team and their individual roles.

Neurosurgeons are primarily focused on the surgical treatment and clinical care of diseases of the central nervous system (brain and spine). Neurosurgeons complete seven years of residency training to learn the ins and outs of neurological surgery before they are qualified to practice independently.

The specifics of this training period will be discussed in another post. Upon completion of their residency training, neurosurgeons have the option to complete a fellowship program.

A fellowship is like an apprenticeship in other professions, where the learner spends focused time with someone who is already a master. During their fellowship, typically lasting one year, newly graduated neurosurgeons work with an expert in their chosen field to improve their own knowledge and skills.

One of these fellowships is in neurosurgical oncology. Neurosurgical oncologists focus on the surgical treatment of tumors in the central nervous system, such as brain and spine tumors. Examples of tumors treated by neurosurgical oncologists include:

• Gliomas 
• Meningiomas 
• Pituitary tumors 
• Craniopharyngiomas
• Acoustic neuromas
• Ependymomas 
• Spinal cord tumors
• Chordomas 
• Chondrosarcomas 

While all neurosurgeons leave residency with the ability to manage and treat tumors of the brain and spine, those completing a fellowship in neurosurgical oncology become experts in this domain of neurosurgery.

While neurosurgical oncologists specialize in brain tumor surgery and treating brain tumor patients, they are also familiar with tumors affecting the spine. Some individuals may choose to further specialize and focus their efforts on treating certain types of tumors.

Neurosurgical oncologists often work together with a team of experts in other aspects of your care to ensure that the patient receives the best and most comprehensive treatment possible. It can often be confusing remembering what everyone’s specialty is and how they will contribute to the patient’s care team. Below is a short description of each specialty the neurosurgical oncologist may work with.

Oncologist: Oncologists are physicians with specialized training in caring for patients with benign tumors and cancers. Oncologists are primarily focused on medical treatment of tumors including chemotherapy. They also function as “the quarterback” of the patient’s care team and coordinate the care with other specialists.

Neurologist: Like neurosurgeons, neurologists treat diseases of the central nervous system.  Unlike neurosurgeons, neurologists do not perform surgery and instead are experts in the medical treatment of nervous system disorders.

Neurologists may be involved in helping to manage the symptoms that develop from your or your loved one’s tumor such as seizures. They are often involved in diagnosing the tumor.

Radiation oncologist: A radiation oncologist is a physician who is trained to treat tumors with radiation therapy. Radiation therapy is sometimes used after surgery in the treatment of tumors of the central nervous system.

Physical medicine and rehabilitation: Throughout your treatment, you may work with physicians or other allied health professionals who specialize in physical medicine.

These individuals are trained to help you or your loved one overcome any limitation that may develop because of your disease and subsequent treatment including during the time of recovery after surgery.

Together, this team of specialists coordinates the surgical, medical, and radiation therapy that may be required to treat tumors of the central nervous system.

Neuro-oncologists are physicians who have completed additional training specific to the medical treatment of nervous system benign and malignant tumors. This is similar to a neurosurgical oncologist who has received specific training in the surgical treatment of the same diseases.

This specialty is at the intersection of neurology and oncology, focusing on both the neurological aspects and the oncological treatment. Unlike neurosurgical oncology, neuro-oncologists use medications, rather than surgical means, for treatment.

You might see a neuro-oncologist for a variety of reasons, primarily related to the diagnosis, treatment, and management of tumors affecting the nervous system. They can also assist with the treatment of complex neurological symptoms such as recurrent seizures and severe headaches.

Besides coordinating care between multiple specialists to create a comprehensive treatment plan, neuro-oncologists can also provide access to specialized treatments such as targeted therapy, immunotherapy, or participation in clinical trials for new treatment modalities.

For the same reasons that you might see a neuro-oncologist, a physician may refer you to a neuro-oncologist if they have reason to suspect that you may be affected with a tumor of the nervous system and would benefit from specialized care.

Neurosurgical oncologists typically treat patients who are referred from other physicians following the diagnosis of a brain tumor. Alternatively, a patient may present to the emergency department and be found to have a brain tumor, resulting in referral to a neurosurgeon.

Once you or a loved one has received a diagnosis of a tumor in the central nervous system, it is important to choose your care team judiciously. When making this decision, there are a few factors to keep in mind.

First, it is important to seek care from a specialist. While all neurosurgeons receive training in the treatment of tumors of the central nervous system, neurosurgical oncologists receive additional, focused training in the management of brain tumors. This added specialization can make a difference in improving outcomes.

Deciding where you will receive treatment is also important. Large academic or university hospitals often have more resources at their disposal to aid in your treatment.

This includes potentially easier access to the experts described above who may contribute to your care. Additionally, these academic hospitals are typically located in more urban settings which can make it easier to receive multiple opinions.

Comparatively, community hospitals are typically located in more suburban or rural areas. These hospitals often have less resources but may be more convenient for you and your family to access. Neurosurgical oncologists can be found in both academic and community hospitals.

When choosing your care team, do not hesitate to seek a second opinion. While this may be intimidating or difficult depending on your circumstances, it is important to find the care team that is right for you. You want to trust your care team so that your journey is more tolerable!

• Neurosurgical oncologists receive additional training specific for the surgical management of tumors of the central nervous system.
• Neurosurgical oncologists work as a member of a diverse group of specialists, all with similar goals. When selecting a neurosurgical oncologist and the rest of your care team, it is important to find the team that best suits your unique needs, and you trust. Do not be afraid to ask questions or seek a second opinion if you feel it is necessary.

• American Brain Tumor Association
• National Brain Tumor Society