Meet the editors

Dr. Lee Roy Morgan is a clinical pharmacologist and oncologist whose research interests are focused on the development of new and novel agents and devices that penetrate the CNS and spine and are effective therapies as treatment for both primary and metastatic malignancies involving the CNS. Dr. Morgan received his PhD degree in Organic Chemistry from Tulane University, New Orleans, Louisiana, USA, in 1960. He com-

pleted postdoctoral studies at Imperial College, University of London, in 1961. In 1971 He received his MD degree from Louisiana State University Medical School, New Orleans. From 1961 to 1986, he was Professor and Chairman, Department of Pharmacology, Louisiana State University Medical Center, New Orleans, Louisiana, USA. He founded DEKK-TEC, Inc., New Orleans, Louisiana, in 1983 and is CEO and Medical Director. In addition, he is Adjunct Professor of Medicine, Tulane University School of Medicine and Adjunct Research Professor of Chemistry, University of New Orleans, both in New Orleans, Louisiana, USA. He has published over 200 research articles and book chapters. Dr. Morgan is married with four children and seven grandchildren.

Feyzi Birol Sarıca, born in 1971 in Germany, graduated from the Medicine Faculty of Ankara University in 1997 and received the title medical doctor. In 2005, he gave his expert thesis called "Prognostic Factors in Supratentorial Glial Tumors" at the Neurosurgery Clinic of Ankara Numune Education and Research Hospital and received the title of neurosurgeon by the Turkish Board of Certification. He worked first as a neurosurgeon and

lecturer in Adana Education and Research Hospital of Medicine Faculty of Baskent University between 2006 and 2015. He then worked at the Kudret International Hospital in Ankara in 2016. He started work as assistant professor at the Department of Neurosurgery of Medicine Faculty of Giresun University in 2017. He took the title of associate professor in March 2018. He is currently serving as the Chairman of the Giresun University Neurosurgery Department. He has participated in cerebrovascular surgery, hydrocephalus and spinal dysraphism, skull base surgery, and gamma-knife radiosurgery training courses. He is interested in general neurosurgery as well as neurooncology and cerebrovascular surgery.

Contents

**Section 1**

**Section 2**

**Section 3**

**Section 4**

*by Feyzi Birol Sarica*

*by Andrew H. Rodgers*

*IDH*-Mutant Gliomas

*by Kensuke Tateishi and Tetsuya Yamamoto*

Intradural Extramedullary Spinal Tumors

*by Saleh Rasras and Arash Kiani*

Jugular Foramen Paragangliomas

Surgery for Recurrent Glioblastoma

**Preface III**

Principles of Neuropharmacology and Experimental Therapeutics **1**

**Chapter 1 3**

Diagnosis of CNS Tumors **13**

**Chapter 2 15**

Spinal Tumors **41**

**Chapter 3 43**

**Chapter 4 55**

Surgical Approaches to CNS Tumors **67**

**Chapter 5 69**

**Chapter 6 79**

*by Breno Nery, Rodrigo Antônio Fernandes Costa, Eduardo Quaggio,* 

*by Vamsi Krishna Yerramneni, Ramanadha Reddy Kanala,* 

Surgical Principles for Spinal and Paraspinal Neurofibromas

*Vasundhara S. Rangan and Thirumal Yerragunta*

*Ricardo Lopes Araújo, Bernardo Alves Barbosa, Diogo Fabricio Coelho de Melo, Carolina Salviano de Abreu Nery, Fred Bernardes Filho and George Peter Stevens*

Principles of Neuropharmacodynamics: As Applied to Neuro-Oncology

## Contents



Preface

Management of primary and metastatic malignancies involving the central nervous system (CNS) (brain and spine) remains a challenge. Although there have been significant improvements in responses to tumor target-directed therapies in recent years, surgery and radiation remain our primary approaches to the management of CNS malignancies. Advanced unresectable primary and secondary tumors of the CNS are commonly "resistant to systemic therapies" because of the lack of knowledge regarding the best mechanism(s) for drugs to penetrate the blood–brain barrier.

Since the book *New Approaches to the Management of Primary and Secondary CNS Tumors* (IntechOpen) was published in 2017, significant progress has been made: Phase I neurooncology trials for new drugs have increased worldwide, several drugs have been approved as target-specific immunotherapies for the management of brain and spinal malignancies, and new pathways for cancer cells to enter the CNS

In addition, major advances in the management of CNS malignancies through molecular and imaging analyses, magnetic devices, and tumor-targeted immunotherapies with/without stereotactic radiosurgery are now available, many of which are discussed in this book. Moreover, the US FDA and other worldwide Orphan Designated Drug and Device programs are inducing incentives for the pharmaceutical and device industries to become more involved in the management of CNS

Every chapter in *Brain and Spinal Tumors—Primary and Secondary* reviews development of new approaches through neurooncological collaborations, in-depth discussions, and/or reviews of diagnostic and therapeutic concepts that will improve the

Metastatic tumors involving the brain and spine are "increasing in occurrence" because drugs are effective versus periphery malignancies (lung, breast, etc.), but are not as effective versus brain and spine malignancies (primary and secondary). Overall, long-term responses for malignancies involving the CNS still remain depressing.

There remains a paucity of useful anticancer therapeutic tools for pediatric and adolescent oncology patients with tumors involving the CNS, who are otherwise healthy, but are seldom referred for clinical trials with novel new agents because they are <18 years of age. However, without new therapies, the management and support for the pediatric and adolescent age groups with primary and secondary CNS malignancies will remain inadequate; these are areas of oncology for which

However, in spite of the above deficiencies, the authors who have written chapters are "weaving their webs and establishing their roles in neurooncology." It is the editors' hopes that all readers are also pursuing their dreams and able to accomplish

have been identified.

malignancies.

*There is light at the end of the tunnel!*

management of patients with neurooncology challenges.

more clinical research efforts are badly needed.
