Hemispheric Intra-Axial Tumors

Gliomas are the most common primary tumors in the brain hemispheres, with glioblastomas being the most frequent and aggressive. The treatment strategy for gliomas typically involves maximum safe resection to provide histopathological diagnosis and cytoreduction, followed by radiotherapy and chemotherapy, especially for high-grade tumors. Advanced intraoperative imaging and direct electrical stimulation are essential for achieving maximal tumor removal while preserving neurological function. Other intra-axial tumors, such as brain metastases and primary CNS lymphomas, also require specific management approaches. Brain metastases, common in adults with systemic malignancies, can require surgical resection followed by adjuvant RT in case of large lesions with symptomatic mass effects. Primary stereotactic radiosurgery and whole-brain RT are reasonable options for all the other patients, according to their performance status and expected survival, as well as the number of lesions and their cumulative intracranial volume. The general approach to central nervous system lymphomas is represented by stereotactic biopsy followed by systemic chemotherapy. Surgery represents the cornerstone of the treatment of brain cavernomas. A multidisciplinary approach is crucial for optimizing patient outcomes and ensuring effective treatment.