Neuro-oncology: an overview

The direct, indirect, and treatment-related effects of cancer on the nervous system have received variable attention by neurologists over the past century. The diseases encompassed in the neuro-oncology field and our understanding of them have increased rapidly during the past 30 years. In part, progress has been driven by technological achievements in neuroimaging, in particular, computed tomography and magnetic resonance imaging. These advances have allowed unprecedented opportunities to view the anatomy and pathology of the central nervous system (CNS) and, to an extent, portions of the peripheral nervous system that could be affected by cancer or its treatment. Clear gains have occurred in diagnostic accuracy, neurosurgical safety, ease of tumor resection, and safer and more accurate radiotherapy. After carmustine chemotherapy was introduced in the late 1960s, neurosurgeons and a new breed of physician, the neuro-oncologist, investigated the clinical benefits of an increasing number of anticancer agents against gliomas, medulloblastomas, and metastatic tumors in the CNS. In parallel, another sector of neuro-oncology developed that was more closely allied with neurology. The focus of this activity was in correlative neurology and pain management issues.