Medicosnext
Dr. Suraj 
He is a senior consultant neurosurgeon at the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Kathmandu, and an Associate Professor of Neurosurgery at Kathmandu University. With specialized expertise in neuro-oncology, cerebrovascular surgery, and spinal disorders, he is dedicated to delivering patient-centered, evidence-based neurosurgical care. Dr. Thulung is actively involved in mentoring neurosurgery residents under the National Board of Medical Specialties (NBMS) program and plays a key role in advancing neurosurgical education, research, and clinical standards in Nepal.
Neuro-oncology—the field that focuses on brain and spinal cord tumors—has undergone a major transformation. What was once a field guided mostly by microscopes and general treatment plans is now being redefined by genetics, advanced imaging, and targeted therapies. Brain and spinal tumors make up only 1–2% of all cancers, yet they cause a significant amount of disability and emotional distress. These tumors affect how we move, think, feel, and communicate—making treatment both urgent and complex. In 2025, we stand at a promising crossroad: blending high-tech tools with personalized care to fight some of the toughest cancers in medicine.
Molecular Medicine: Diagnosing Tumors at Their Core
Gone are the days when brain tumors were diagnosed based solely on how they looked under a microscope. Today, doctors use a patient’s tumor DNA profile to guide diagnosis and treatment—a major leap towards precision medicine.
Key Molecular Markers Include:
1. IDH mutation – often indicates a better prognosis.
2. 1p/19q co-deletion – found in certain treatable tumors like oligodendrogliomas.
3. MGMT promoter methylation – predicts response to chemotherapy.
4. TERT and ATRX mutations – used in tumor grading and risk stratification.
This molecular information helps doctors personalize treatments, avoid unnecessary toxicity, and improve survival.
Smarter Surgeries: Safe and Sophisticated
Surgery remains the foundation for treating many brain and spinal tumors. But now, it’s backed by some of the most advanced technologies in modern medicine.
Surgical Innovations Include:
1. Fluorescence-guided surgery (5-ALA) – makes tumors glow under special light.
2. Intraoperative MRI and CT – real-time imaging during surgery.
3. Awake craniotomies – help preserve speech and movement centers.
4. Neuronavigation & fiber tracking – GPS-like mapping of the brain.
5. Ultrasound and endoscopic techniques – enable minimally invasive access.
These tools allow surgeons to remove as much tumor as possible while protecting vital brain functions.
Radiation, Chemotherapy & Beyond: Modern Therapy Options
Standard therapy for aggressive tumors like glioblastoma still includes a mix of surgery, radiation, and chemotherapy. One common combination is the Stupp regimen: radiation plus temozolomide.
Newer Approaches:
1. Stereotactic radiosurgery (SRS) – precise radiation that spares healthy brain tissue.
2. Proton beam therapy – a gentler form of radiation, especially helpful in children.
3. Tumor Treating Fields (TTF) – a wearable device that uses electric fields to slow tumor growth.
For patients with certain mutations, targeted therapies (like BRAF or IDH inhibitors) and immunotherapies (such as CAR-T cells or checkpoint inhibitors) are in trials or early use.
Collaborative Care: Teamwork That Transforms Outcomes
Effective treatment now requires a multidisciplinary team, including:
1. Neurosurgeons
2. Neuro-oncologists
3. Radiation oncologists
4. Radiologists
5. Neuropathologists
6. Rehabilitation and palliative care specialists
This integrated approach ensures patients receive the best medical, emotional, and quality-of-life care throughout their journey.
What Are the Ongoing Challenges?
Despite breakthroughs, several hurdles remain:
1. The blood-brain barrier (BBB) blocks many potentially life-saving drugs.
2. Tumor heterogeneity means not all tumor cells respond the same way.
3. Side effects from treatment can impact memory, thinking, and mood.
4. Access to new treatments and clinical trials remains uneven.
5. End-of-life and palliative care is still underutilized.
Final Thoughts: From Surviving to Thriving
We’ve made real progress—but we’re not done yet. Neuro-oncology is shifting from merely treating disease to helping people live well through and beyond their diagnosis. For patients, caregivers, and doctors alike, 2025 offers a message of hope: with ongoing research, technological innovation, and compassionate care, we are closer than ever to transforming the future of brain tumor treatment.
