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Brain Tumors: Evaluation and Physiotherapy Management | Medical, Surgical & Neurorehabilitation Approaches

This presentation provides a comprehensive, evidence-based overview of brain tumors from a physiotherapy and neurorehabilitation perspective. It covers the classification and WHO grading of brain tumors, etiology, pathophysiology, clinical manifestations, neurological evaluation, diagnostic investigations, differential diagnosis, medical and surgical management, ICF-based rehabilitation, physiotherapy assessment, neurophysiological approaches, management of systemic and mechanical complications, outcome measures, prognostic factors, and case-based clinical application. Designed for BPT, MPT, DPT, medical, nursing, and allied health students, as well as rehabilitation professionals, this presentation integrates current clinical guidelines and contemporary neuro-oncology rehabilitation principles. Emphasis is placed on clinical reasoning, evidence-based physiotherapy interventions, multidisciplinary management, patient-centered care, and functional recovery using the International Classification of Functioning, Disability and Health (ICF) framework. Topics Covered: • Introduction to Brain Tumors • WHO Classification & Grading • Etiology & Risk Factors • Pathophysiology • Clinical Manifestations • Neurological & Functional Assessment • Diagnostic Investigations • Differential Diagnosis • Medical & Surgical Management • ICF-Based Rehabilitation • Physiotherapy Management • Neurophysiological Approaches • Complication Management • Outcome Measures • Prognostic Factors • Case Study • Key Take-Home Messages This presentation is intended for academic teaching, classroom learning, seminar presentations, and clinical training in neurorehabilitation and neurophysiotherapy.

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Evaluation and Physiotherapy Management of Brain Tumors Presented by: Dr. Etika Rana (PT) BPT, MPT (Neurology), PhD Scholar Maharishi Markandeshwar Institute of Physiotherapy & Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana
Learning Objectives ✔ Define and classify brain tumors. ✔ Describe the epidemiology, etiology, and pathophysiology of brain tumors. ✔ Recognize the common clinical manifestations. ✔ Perform a comprehensive neurological and functional assessment. ✔ Formulate physiotherapy diagnosis, identify impairments, and prioritize problems. ✔ Develop evidence-based rehabilitation goals and treatment plans. ✔ Understand current medical, surgical, and physiotherapy management strategies. ✔ Apply neurophysiological approaches and therapeutic modalities appropriately.
What is a Brain Tumor? A brain tumor is an abnormal growth of cells within the brain or its surrounding structures that may be benign (non-cancerous) or malignant (cancerous). Tumors can arise from the brain itself (primary tumors) or spread from cancers elsewhere in the body (secondary/metastatic tumors). Key Characteristics ✓ May originate from: Brain parenchyma , Meninges , Cranial nerves , Pituitary gland , Metastatic lesions ✓ Produces neurological dysfunction by: Compression , Invasion , Edema, Raised intracranial pressure (ICP)
Types of Origin Primary Brain Tumors Secondary (Metastatic) Brain Tumors Originate within the CNS Spread from cancers elsewhere Glioma Lung carcinoma Meningioma Breast carcinoma Pituitary adenoma Melanoma Schwannoma Renal carcinoma
Classification of Brain Tumors
WHO Classification of Primary Brain Tumors Tumor Type Common Examples WHO Grade Gliomas Pilocytic astrocytoma, Diffuse astrocytoma, Glioblastoma I–IV Meningiomas Meningothelial, Fibrous, Anaplastic I–III Pituitary Tumors Pituitary adenoma Usually benign Cranial Nerve Tumors Vestibular schwannoma I Embryonal Tumors Medulloblastoma IV CNS Lymphoma Diffuse large B-cell lymphoma High grade
WHO Grades of Brain Tumors WHO Grade Biological Behavior Growth Rate Recurrence Prognosis Examples Grade I Well-circumscribed, non-invasive Slow Rare after complete excision Excellent Pilocytic astrocytoma, Vestibular schwannoma, Most meningiomas Grade II Diffusely infiltrative, low-grade Slow to moderate Common Good– Intermediat e Diffuse astrocytoma, Oligodendroglioma Grade III Malignant (anaplastic) Rapid Frequent Poor Anaplastic astrocytoma, Anaplastic oligodendroglioma Grade IV Highly malignant with necrosis and/or microvascular proliferation Very rapid Very frequent Poor Glioblastoma, Diffuse midline glioma (H3 K27- altered)*
Etiology & Risk Factors
Risk Factors Established Risk Factors Possible/Associated Risk Factors Ionizing radiation Advanced age Genetic syndromes Male sex (glioma) Family history (rare) Female sex (meningioma) Certain hereditary mutations Immunosuppression (CNS lymphoma) Previous malignancy (brain metastasis) Occupational/environmental exposure (limited evidence)
Common Genetic Syndromes Syndrome Associated Brain Tumor Neurofibromatosis Type 1 Optic pathway glioma Neurofibromatosis Type 2 Vestibular schwannoma, Meningioma Tuberous sclerosis Subependymal giant cell astrocytoma (SEGA) Li–Fraumeni syndrome Glioma Von Hippel–Lindau disease Hemangioblastoma
Pathophysiolog y of Brain Tumors
Stage Pathophysiological Changes Clinical Consequences 1. Genetic & Molecular Alterations Mutations in oncogenes and tumor suppressor genes lead to uncontrolled cellular proliferation and resistance to apoptosis. Tumor initiation 2. Tumor Growth Progressive expansion and infiltration of surrounding brain tissue. Local tissue destruction and neurological dysfunction 3. Mass Effect Compression and displacement of adjacent neural structures. Focal neurological deficits, seizures 4. Peritumoral Edema Disruption of the blood–brain barrier causes vasogenic edema. Increased intracranial pressure (ICP) and worsening neurological deficits 5. Vascular Compression Compression of cerebral vessels reduces cerebral blood flow. Ischemia and neuronal injury 6. CSF Flow Obstruction Obstruction of ventricular pathways impairs CSF circulation. Hydrocephalus and further elevation of ICP 7. Raised Intracranial Pressure (ICP) Increased intracranial volume exceeds compensatory mechanisms (Monro–Kellie doctrine). Headache, vomiting, papilledema, altered consciousness 8. Neuronal Dysfunction Impaired neuronal conduction and loss of functional neural networks. Motor, sensory, cognitive, cranial nerve, and cerebellar deficits 9. Functional Disability Progressive impairment of body functions and activities. Reduced mobility, ADL limitations, decreased quality of life
Major Mechanisms Producing Neurological Deficits Mechanism Effects Mass Effect Compression of adjacent brain tissue causing focal neurological deficits. Tumor Infiltration Direct destruction of neurons and white matter tracts leading to progressive neurological impairment. Vasogenic Edema Increased extracellular fluid causing elevated ICP and worsening neurological symptoms. Raised Intracranial Pressure Reduced cerebral perfusion pressure, headache, nausea, vomiting, papilledema, and altered consciousness. Hydrocephalus Ventricular dilatation due to CSF obstruction resulting in gait disturbance, cognitive decline, and urinary incontinence (particularly in chronic cases). Seizure Generation Cortical irritation by the tumor and surrounding edema producing focal or generalized seizures.
Clinical Correlation Tumor Location Common Manifestations Frontal lobe Personality changes, executive dysfunction, contralateral weakness Parietal lobe Sensory deficits, neglect, apraxia Temporal lobe Memory impairment, aphasia, seizures Occipital lobe Visual field defects Cerebellum Ataxia, dysmetria, impaired balance Brainstem Cranial nerve palsies, dysphagia, respiratory dysfunction
Clinical Manifestations of Brain Tumors • A. General Symptoms (Raised Intracranial Pressure) Symptom Clinical Features Headache Progressive, worse in the morning or with Valsalva maneuvers Nausea & Vomiting Often projectile; associated with raised ICP Papilledema Blurred vision, transient visual obscurations Altered Consciousness Drowsiness, confusion, decreased alertness Seizures Focal or generalized; may be the first presentation
B. Focal Neurological Deficits Affected Region Clinical Manifestations Frontal Lobe Contralateral weakness, personality changes, executive dysfunction, expressive aphasia (dominant hemisphere) Parietal Lobe Sensory loss, neglect, apraxia, impaired spatial awareness Temporal Lobe Memory impairment, receptive aphasia, auditory hallucinations, seizures Occipital Lobe Visual field defects (homonymous hemianopia), cortical blindness Cerebellum Ataxia, dysmetria, intention tremor, nystagmus Brainstem Cranial nerve palsies, dysphagia, dysarthria, respiratory dysfunction
C. Red Flag Symptoms • Progressive neurological deficits • New-onset seizures in adults • Persistent morning headache with vomiting • Altered mental status • Papilledema • Rapid deterioration in neurological function
Clinical Evaluation of a Patient with Brain Tumor Subjective Assessment Objective Assessment Functional Assessment ✓ History ✓ Observation ✓ Bed mobility ✓ Present illness ✓ Palpation ✓ Transfers ✓ Medical history ✓ Higher mental functions ✓ Sitting & standing balance ✓ Surgical history ✓ Cranial nerve examination ✓ Gait analysis ✓ Medications ✓ Motor examination ✓ ADL performance ✓ Functional complaints ✓ Sensory examination ✓ Community participation ✓ Pain & fatigue ✓ Reflex testing ✓ Quality of life ✓ Seizure history ✓ Coordination ✓ Outcome measures
Goals of Clinical Evaluation • Identify neurological impairments. • Determine functional limitations. • Establish baseline functional status. • Detect medical and rehabilitation precautions. • Formulate physiotherapy diagnosis. • Develop individualized rehabilitation goals.
History Taking in Patients with Brain Tumors Domain Key Information to Obtain Chief Complaint Headache, seizures, weakness, sensory disturbances, visual impairment, balance problems History of Present Illness Onset, duration, progression, aggravating/relieving factors, associated symptoms Medical History Previous neurological disorders, hypertension, diabetes, cancer, radiation exposure Surgical History Craniotomy, biopsy, VP shunt, previous neurosurgical procedures Medication History Corticosteroids, antiepileptics, chemotherapy, anticoagulants, analgesics Family History Brain tumors, neurofibromatosis, Li–Fraumeni syndrome, other hereditary cancers Social & Occupational History Occupation, smoking, alcohol use, social support, home environment Functional History Mobility, ADLs, employment, participation restrictions, assistive device use
Symptom Analysis (SOCRATES) Parameter Assessment Site Location of symptoms (headache, weakness, sensory loss) Onset Sudden or gradual Character Throbbing, dull, burning, numbness Radiation Spread of pain or neurological symptoms Associated Symptoms Seizures, vomiting, vision changes, speech difficulty Timing Frequency, duration, progression Exacerbating/Relieving Factors Coughing, bending, medications, rest Severity Pain scale (VAS/NRS), functional impact
Observation & General Examination Parameter Clinical Findings Level of Consciousness Alert, drowsy, confused, stuporous, comatose (Glasgow Coma Scale) General Appearance Distress, fatigue, nutritional status, body build Posture Symmetry, abnormal head posture, trunk alignment, protective positioning Facial Expression Facial asymmetry, emotional lability, masked facies Communication Speech fluency, dysarthria, aphasia, ability to follow commands
General Physical Examination Assessment Clinical Relevance Vital Signs Blood pressure, heart rate, respiratory rate, oxygen saturation, temperature Respiratory Pattern Dyspnea, abnormal breathing, secretion retention Skin Integrity Pressure injuries, surgical incision, wound healing Edema Limb or facial swelling Medical Devices IV lines, urinary catheter, feeding tube, VP shunt, tracheostomy
Cranial Nerve Examination Cranial Nerve Assessment Common Findings in Brain Tumors CN I – Olfactory Identify familiar odors Reduced or loss of smell (anosmia) CN II – Optic Visual acuity, visual fields, fundoscopy Visual field defects, reduced vision, papilledema CN III, IV & VI – Oculomotor Complex Eye movements, pupil size, light reflex Diplopia, ophthalmoplegia, ptosis, abnormal pupillary reflex CN V – Trigeminal Facial sensation, muscles of mastication Facial numbness, weak jaw muscles CN VII – Facial Facial symmetry, expressions, eye closure Facial weakness or asymmetry CN VIII – Vestibulocochlear Hearing, vestibular function Hearing loss, tinnitus, vertigo, imbalance CN IX & X – Glossopharyngeal & Vagus Palatal movement, gag reflex, swallowing Dysphagia, dysarthria, hoarseness CN XI – Accessory Shoulder shrug, head rotation Weak trapezius or sternocleidomastoid CN XII – Hypoglossal Tongue movements Tongue deviation, dysarthria
Tumor Location Likely Cranial Nerve Involvement Pituitary/Suprasellar CN II Cerebellopontine Angle CN V, VII, VIII Brainstem Multiple cranial nerves (III–XII) Skull Base Variable cranial nerve deficits depending on lesion site
Component Assessment Common Findings in Brain Tumors Higher Mental Functions Consciousness, orientation, memory, attention, language, executive function Cognitive impairment, aphasia, altered behavior Cranial Nerves CN I–XII examination Visual deficits, facial weakness, hearing loss, dysphagia, dysarthria Motor System Muscle bulk, tone, MRC muscle strength, ROM, voluntary control Hemiparesis, spasticity, hypotonia, impaired postural control Sensory System Light touch, pain, temperature, proprioception, vibration, cortical sensation Contralateral sensory loss, neglect, impaired proprioception Reflexes Deep tendon, superficial and pathological reflexes Hyperreflexia, Babinski sign, clonus Coordination Finger–nose, heel–shin, rapid alternating movements Dysmetria, dysdiadochokinesia, intention tremor Balance Sitting, standing, Romberg, tandem stance Postural instability, increased fall risk Gait Walking pattern, cadence, step length, base of support Hemiplegic, ataxic, spastic or cautious gait
Diagnostic Investigations Investigation Purpose Key Findings Magnetic Resonance Imaging (MRI) – Gold Standard Tumor localization, size, edema, mass effect Contrast enhancement, midline shift, infiltration Computed Tomography (CT) Emergency assessment, hemorrhage, calcification, hydrocephalus Acute bleeding, bony involvement Brain Biopsy / Histopathology Definitive diagnosis Tumor type, WHO grade, molecular markers Molecular & Genetic Testing Tumor classification and prognosis IDH mutation, 1p/19q codeletion, MGMT promoter methylation (gliomas) Positron Emission Tomography (PET) Tumor metabolism and recurrence Differentiate recurrence from radiation necrosis Electroencephalography (EEG) Evaluation of seizures Epileptiform discharges Laboratory Investigations Preoperative and treatment monitoring CBC, coagulation profile, electrolytes, liver & renal function
Differential Diagnosis of Brain Tumors Condition Clinical Features Distinguishing Findings Brain Tumor Progressive headache, seizures, focal neurological deficits, cognitive decline MRI shows space-occupying lesion with mass effect Stroke Sudden onset of neurological deficits CT/MRI demonstrates ischemia or hemorrhage; acute presentation Brain Abscess Fever, headache, focal deficits Ring-enhancing lesion with systemic signs of infection Subdural Hematoma Head injury, altered consciousness Crescent-shaped hematoma on CT scan Meningitis/ Encephalitis Fever, neck stiffness, altered mental status CSF abnormalities, meningeal signs Multiple Sclerosis Episodic neurological deficits Multiple demyelinating plaques on MRI Hydrocephalus Gait disturbance, cognitive impairment, urinary incontinence Ventricular enlargement on imaging Brain Metastasis History of systemic malignancy Multiple enhancing lesions on MRI
Feature Brain Tumor Stroke Brain Abscess Onset Gradual Sudden Subacute Fever Rare No Common Seizures Common Less common Common Headache Progressive Variable Severe Imaging Mass lesion Infarct/ hemorrhage Ring-enhancing lesion
Medical Management of Brain Tumors Objectives of Medical Management • Relieve neurological symptoms • Control tumor growth • Reduce intracranial pressure • Prevent complications • Improve quality of life • Prepare patients for surgery or rehabilitation
Treatment Purpose Common Examples Corticosteroids Reduce peritumoral edema and intracranial pressure Dexamethasone Antiepileptic Drugs (AEDs) Control seizures Levetiracetam, Valproate Osmotic Therapy Emergency reduction of raised ICP Mannitol, Hypertonic saline Analgesics & Antiemetics Symptom relief Paracetamol, Ondansetron Chemotherapy Destroy or slow tumor cell growth Temozolomide Targeted Therapy Acts on specific molecular pathways Bevacizumab (selected cases) Immunotherapy Enhances immune response against tumor (selected tumors) Emerging/selected indications
Surgical Management of Brain Tumors • Objectives of Surgery • Obtain definitive diagnosis (biopsy) • Achieve maximal safe tumor resection • Reduce mass effect and intracranial pressure • Relieve neurological symptoms • Improve survival and functional outcomes
Procedure Indications Purpose Stereotactic Biopsy Deep-seated or inoperable tumors Histopathological diagnosis Craniotomy with Tumor Resection Accessible primary brain tumors Maximal safe tumor removal Awake Craniotomy Tumors near eloquent cortex Preserve speech and motor function Endoscopic Tumor Resection Selected ventricular or skull-base tumors Minimally invasive excision CSF Diversion (VP Shunt/ETV) Hydrocephalus due to CSF obstruction Reduce intracranial pressure
Potential Postoperative Complications Neurological General Hemiparesis Pain Cranial nerve deficits Wound infection Seizures Deep vein thrombosis Cerebral edema Pulmonary complications Cognitive impairment Pressure injuries Balance & gait disturbances Fatigue
Physiotherapy Goals After Surgery Phase Goals Acute (0–7 days) Prevent complications, chest care, positioning, ROM, early mobilization Subacute Improve sitting and standing balance, transfers, strength, gait training Rehabilitation Restore functional independence, endurance, community mobility, participation
Physiotherapy Management Rehabilitation Goals • Acute Phase (ICU/Early Postoperative) • Prevent secondary complications • Maintain airway clearance and optimize ventilation • Prevent pressure injuries and contractures • Maintain joint range of motion • Promote early mobilization • Improve sitting tolerance
Subacute Phase • Improve trunk control • Restore postural stability • Improve muscle strength and endurance • Enhance balance and coordination • Facilitate gait and transfer training • Improve functional independence Chronic Phase • Maximize community reintegration • Improve participation in daily activities • Enhance cardiovascular fitness • Reduce fall risk • Improve quality of life • Encourage lifelong physical activity
Evidence-Based Physiotherapy Interventions Intervention Purpose Positioning Prevent pressure injuries, reduce edema, optimize alignment Chest Physiotherapy Improve airway clearance and prevent pulmonary complications ROM Exercises Prevent joint stiffness and contractures Progressive Strengthening Improve muscle performance and functional mobility Balance Training Improve postural control and reduce falls Gait Training Restore safe and efficient walking Functional Task Practice Improve ADLs and independence Patient & Caregiver Education Promote safety and home management
Neurophysiological Approaches & Therapeutic Modalities Approach Principle Clinical Application in Brain Tumors Bobath (NDT) Facilitation of normal movement and postural control Improve trunk control, postural alignment, and functional mobility PNF Facilitation using diagonal movement patterns and proprioceptive input Enhance strength, coordination, and motor control Motor Relearning Programme (MRP) Task-oriented practice with repetitive functional training Improve ADLs and functional task performance Task-Oriented Training Repetitive practice of meaningful activities Enhance transfers, balance, gait, and upper-limb function Constraint-Induced Movement Therapy (CIMT) Intensive use of the affected upper limb Improve upper-limb function in selected patients with adequate voluntary movement Mirror Therapy Visual feedback to facilitate cortical reorganization Improve upper-limb motor recovery and movement awareness Vestibular Rehabilitation Gaze stabilization and balance retraining Reduce dizziness and improve balance in cerebellar/vestibular involvement
Therapeutic Modalities Modality Purpose Functional Electrical Stimulation (FES) Facilitate muscle activation and improve gait Neuromuscular Electrical Stimulation (NMES) Strengthen weak muscles and prevent disuse atrophy Biofeedback Improve voluntary motor control and muscle activation Virtual Reality (VR) Enhance balance, coordination, and patient engagement Body Weight–Supported Treadmill Training (BWSTT) Facilitate gait retraining in patients with impaired mobility Robotic-Assisted Therapy Provide intensive, repetitive upper- and lower-limb training
Selection of Physiotherapy Approaches Clinical Problem Recommended Approach Impaired postural control Bobath (NDT), Task-Oriented Training Muscle weakness PNF, Strengthening, NMES Upper-limb dysfunction CIMT, Mirror Therapy, Functional Task Practice Balance impairment Vestibular Rehabilitation, Balance Training, VR Gait dysfunction BWSTT, Task-Oriented Gait Training, FES Reduced functional independence Motor Relearning Programme, Task-Oriented Training
Management of Systemic & Mechanical Complications Complication Clinical Features Physiotherapy Management Deep Vein Thrombosis (DVT) Limb pain, swelling, warmth Early mobilization*, ankle pumps, compression devices (as prescribed) Pulmonary Complications Atelectasis, secretion retention, reduced ventilation Breathing exercises, incentive spirometry, chest physiotherapy, early ambulation Pressure Injuries Skin redness, tissue breakdown Regular repositioning, pressure- relieving surfaces, skin inspection Cancer-Related Fatigue Reduced endurance, generalized weakness Energy conservation, graded aerobic exercise, pacing Deconditioning Muscle weakness, reduced exercise tolerance Progressive strengthening, endurance training, functional mobility
Mechanical Complications Complication Clinical Features Physiotherapy Management Spasticity Increased muscle tone, abnormal posture Stretching, positioning, task-specific training, splinting (when indicated) Contractures Reduced joint ROM ROM exercises, prolonged stretching, positioning Shoulder Pain/Subluxation Pain, instability, limited upper- limb function Proper positioning, supported handling, strengthening, scapular stabilization Balance Impairment Postural instability Static & dynamic balance training, fall prevention Gait Dysfunction Hemiplegic, ataxic, or spastic gait Task-oriented gait training, assistive devices, BWSTT/FES where appropriate Falls Loss of balance Fall-risk assessment, environmental modification, caregiver education
Prevention Strategies • Early mobilization • Regular positioning and pressure relief • Daily range-of-motion exercises • Progressive strengthening and endurance training • Appropriate assistive devices • Patient and caregiver education • Home safety assessment • Regular reassessment and follow-up
Outcome Measures in Brain Tumor Rehabilitation Domain Outcome Measure Purpose Muscle Strength Medical Research Council (MRC) Scale Assess muscle strength Spasticity Modified Ashworth Scale (MAS) Evaluate muscle tone Balance Berg Balance Scale (BBS) Assess static and dynamic balance Mobility Timed Up and Go (TUG) Functional mobility and fall risk Walking Capacity 10-Meter Walk Test (10MWT), 6- Minute Walk Test (6MWT) Walking speed and endurance Functional Independence Functional Independence Measure (FIM) / Barthel Index ADL performance Cognition Montreal Cognitive Assessment (MoCA) / Mini-Mental State Examination (MMSE) Cognitive screening Performance Status Karnofsky Performance Status (KPS) / ECOG Performance Status Overall functional status Quality of Life EORTC QLQ-C30 with BN20 Brain Module Health-related quality of life
Key Take-Home Messages • Brain tumors may be primary or metastatic and can produce significant neurological impairment through mass effect, edema, and raised intracranial pressure. • Clinical manifestations depend primarily on the tumor location, growth rate, and degree of intracranial pressure rather than tumor size alone. • Contrast-enhanced MRI is the imaging modality of choice, while histopathological and molecular analyses confirm the diagnosis and WHO grade. • Comprehensive neurological and functional assessment is essential for identifying impairments and planning individualized rehabilitation. • Early surgical intervention, when indicated, combined with appropriate medical management improves neurological outcomes and survival. • Physiotherapy should begin as early as the patient's medical condition allows to prevent secondary complications and promote functional recovery. • Task-specific, goal-oriented, and individualized rehabilitation is the cornerstone of neurorehabilitation following brain tumor treatment. • Effective rehabilitation requires a multidisciplinary approach involving neurosurgeons, oncologists, physiatrists, physiotherapists, occupational therapists, speech-language pathologists, psychologists, nurses, and caregivers. • Regular reassessment using standardized outcome measures is necessary to monitor progress and optimize rehabilitation goals. • The ultimate goal of rehabilitation is to maximize independence, community participation, and quality of life.
REFRENCES • Braddom RL, editor. Braddom's Physical Medicine and Rehabilitation. 7th ed. Philadelphia: Elsevier; 2026. • O'Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. 8th ed. Philadelphia: F.A. Davis; 2023. • Umphred DA, Lazaro RT, Roller ML, Burton GU. Umphred's Neurological Rehabilitation. 7th ed. St. Louis: Elsevier; 2020. • Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 5th ed. St. Louis: Elsevier; 2023. • World Health Organization Classification of Tumours Editorial Board. Central Nervous System Tumours. WHO Classification of Tumours Series. 5th ed. Lyon: International Agency for Research on Cancer; 2021. • Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: A Summary. Neuro Oncol. 2021;23(8):1231–1251. • Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021;18(3):170–186. • Le Rhun E, Guckenberger M, Smits M, et al. EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastases from solid tumours. Ann Oncol. 2021;32(11):1332–1347. • National Institute for Health and Care Excellence (NICE). Brain Tumours (Primary) and Brain Metastases in Adults (NG99). Updated 2021.
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