About Brain Tumors

Brain tumors can be benign (non-cancerous, not likely to spread) or malignant (cancerous, able to spread). Malignant brain tumors are further classified into grades based on how aggressively they are likely to spread. Tumors that begin in the brain are called primary brain tumors; tumors that have spread from another location are called secondary tumors.


The symptoms of a brain tumor tend to depend on its size and exact location within the brain. Brain tumors may cause problems throughout the body, though, as they increase pressure within the confines of the skull or interfere with the circulation of cerebrospinal fluid. These problems often cause headaches (especially in the morning), nausea, vomiting, seizures, personality changes, or other symptoms. (Please note that while brain tumors may often cause headaches, nausea and vomiting, they are not the most common cause of these symptoms.)


Small, slow-growing, benign brain tumors are sometimes simply monitored to see whether they need treatment. More aggressive tumors, or tumors that interfere with the tissue around them, are often treated with surgery. Tumor tissue removed during surgery can be analyzed to get more information about the tumor and guide treatment decisions. In other cases, a biopsy (tissue sample) may be taken in a separate procedure from tumor removal.

Below are two videos of Dr. Sisti sharing his knowledge of and treatment for 1) metastatic and 2) malignant brain tumors.

See Dr. Sisti’s publications on Brain Tumor’s


The following are the most common symptoms of a brain tumor; however, each person may experience symptoms differently. Symptoms vary depending on the size and location of tumor, and many symptoms are related to an increase in pressure in or around the brain because there is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue or fluid can cause pressure on the brain and lead to increased intracranial pressure. In particular, increased intracranial pressure can be caused by a tumor blocking one or more of the ventricles that drain cerebrospinal fluid, leading to hydrocephalus.

Increased intracranial pressure may lead to headache, vomiting, nausea, personality changes, irritability, drowsiness, depression and decreased cardiac and respiratory function, which can eventually lead to coma if not treated.

One of the most common symptoms of brain tumors is headache, but the majority of headaches are not caused by brain tumors. Headaches caused by brain tumors tend to worsen when lying down or upon first waking; they tend to recur, eventually becoming constant.

Symptoms are usually specific to where a brain tumor is located and its size.

Symptoms of brain tumors in the cerebrum may include:

  • Increased intracranial pressure
  • Seizures
  • Visual changes, such as vision loss
  • Slurred speech
  • Aphasia
  • Loss of ability to write
  • Impaired sense of smell
  • Drowsiness
  • Personality changes
  • Impaired judgment
  • Difficulty remembering and memory loss
  • Hemiparesis or hemiplegia
  • Gait disturbances

Symptoms of brain tumors in the brainstem may include:

  • Increased intracranial pressure
  • Seizures
  • Endocrine problems
  • Visual changes or diplopia
  • Headaches
  • Hemiparesis or hemiplegia
  • Respiratory changes
  • Clumsy, uncoordinated gait
  • Hearing loss
  • Personality changes

Symptoms of brain tumors in the cerebellum may include:

  • Increased intracranial pressure
  • Vomiting
  • Headache
  • Uncoordinated muscle movements
  • Nystagmus
  • Ataxia

The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Causes and Risk Factors

The exact cause of most brain tumors is unclear.

For many tumors, genetic mutations or chromosomal abnormalities are known to be associated with tumor occurence.

Most brain tumors are sporadic, but some are linked to certain genetic conditions, such as neurofibromatosis type I and II, von Hippel-Lindau disease, Li-Fraumeni syndrome, Turcot syndrome, tuberous sclerosis and nevoid basal cell carcinoma syndrome.

Individuals who have received radiation therapy to the head as part of prior treatment for other malignancies have an increased risk for new brain tumors.

Brain tumors can occur at any age but are most common during early or middle adulthood. Both men and women can have brain tumors but men have a slightly higher risk.

Tests and Diagnosis

In addition to a complete medical history and physical examination, a neurological examination is usually conducted to identify symptoms and any problems. This exam consists of evaluating eye movements, hearing, sensation, motor function, swallowing, sense of smell, balance and coordination.

The primary component of diagnosing brain tumors is imaging studies. The preferred imaging test is most often a magnetic resonance imaging (MRI) scan because it provides superior tumor detail, but a computed tomography (CT) scan is a good alternative. MRI or CT scans may be performed with or without contrast enhancement.

Depending on the suspected tumor type, additional procedures may be performed that include:

  • A cerebral angiogram, a minimally invasive procedure, can be performed to image the blood vessels in the tumor, particularly for highly vascular tumors.
  • An X-ray of the chest may be performed to identify where in the body the tumor started before it metastasized to the brain.
  • A bone scan can be used to detect tumors and bone abnormalities.
  • A myelogram may be done to detect tumor metastasis.
  • Spinal tap, a procedure in which a special needle is placed into the spinal canal, may be done to obtain a small amount of cerebrospinal fluid for testing to identify cancer cells or determine if there is an infection or other problems.
  • A blood draw may be done to check for tumor markers that indicate a particular tumor type.
  • Positron emission tomography (PET) scan, which involves injecting radioactive glucose so that it can be traced in the body, can be used to detect malignant tumor cells, which are more active and therefore take up more glucose than normal cells do.
  • Magnetic resonance spectroscopy (MRS) is a procedure that detects the chemical composition of the tumor as a means to identifying the tumor type.

To confirm a diagnosis, a biopsy is typically performed before or during surgery.

Surgical Treatment

At Columbia, our neurosurgeons use the latest surgical techniques to successfully treat brain tumors, providing the best possible outcome for each patient. Specific treatment for brain tumors depends on several factors, such as type, location and size of the tumor in addition to an individual’s age, overall health and medical history.

For most brain tumors, the first step of treatment is usually surgery, the goal of which is to remove as much of the tumor as possible while maintaining neurological function. If complete resection is achieved, the tumor may be cured; however, for some tumors, only subtotal resection is possible because otherwise normal brain tissue could risk damage. Our highly skilled neurosurgeons are careful to excise as much tumor as possible while preserving brain tissue and overall function.

Brain tumor surgery can be performed by craniotomy or transsphenoidal surgery to remove the tumor, depending on what is best for the patient and tumor type. If hydrocephalus is present, a ventriculoperitoneal shunt will need to be surgically placed into the blocked ventricle before or during surgery. The other end of the tube is placed into the abdomen to help drain excess fluid that can otherwise build up in the brain and cause an increase in pressure inside the skull.

If residual tumor remains, adjuvant therapy along with radiation therapy, chemotherapy or both may be needed.

One of the newer therapies that may be used to treat brain cancer is stereotactic radiosurgery. This technique focuses high doses of radiation at the tumor site, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt X-rays.

Dr. Richard Anderson (Pediatric), Dr. Jeffrey Bruce,  Dr. Sean Lavine, Dr. Grace Mandigo, Dr. Guy McKhann, Dr. Marc Otten, Dr. Sameer Sheth and Dr. Michael Sisti are experts in diagnosing and surgically treating brain tumors. They can also provide a second opinion.

What Happens When a Neurosurgeon Needs a Neurosurgeon?

What Happens When a Neurosurgeon Needs a Neurosurgeon?

When Brazilian neurosurgeon Jose Nasser felt numbness on one side of his face, he hoped it was a minor nerve problem and that it would go away quickly. But he decided to have an MRI done just in case. The MRI showed that Dr. Nasser had an acoustic neuroma, a tumor...

Dr. Michael Sisti’s Patient Lives Olympic Dream

Dr. Michael Sisti’s Patient Lives Olympic Dream

It has been a few years since we shared the inspiring story of the olympian Josephine Pucci.  And now, with the 2018 Winter Olympics underway in South Korea, we thought, what better time to put her story front and center once again. Before we do, we'd like to give you...

Dr. Sisti’s Patient ‘In Great Hands’

Dr. Sisti’s Patient ‘In Great Hands’

When Jodie Leitner went to a routine checkup in the fall of 2014, she told her doctor she had been having unusual headaches. “I had had sinus headaches in the past,” she says, “and these headaches were different.” So her doctor sent her for an MRI. The MRI showed a...

A Patient Surprises Dr. Sisti With a Gift No Money Can Buy

A Patient Surprises Dr. Sisti With a Gift No Money Can Buy

  The gifts that move us, tug at our hearts, come when we least expect them and, in an instant, remind us of what’s important. Looking at the gift-wrapped box from his patient, Dr. Michael B. Sisti of Columbia Neurosurgery, didn’t know what the contents could be....

Insurance Participation

Have a question?

Health is a matter of choice - Contact Us!