Apart from a small percentage of benign tumours (most meningiomas and pituitary adenomas) neoplasms of the central nervous system are progressive and not curable. Initial management with surgery or radiotherapy (and sometimes chemotherapy) will often lead to a resolution of symptoms for a variable period, but cure cannot be promised, and a recurrence of tumour is virtually inevitable.

Cerebral metastases from tumours elsewhere are more common than primary brain malignancies. They occur in about 20% of adult cancer cases, and are more often multiple, with more widely dispersed neurological manifestations than the solitary brain lesions. However, resection of solitary metastases may be performed to combat the threat of distressing cerebral symptoms, and can provide a window of good function and hope not dissimilar to resection of a primary tumour.

Secondary spread of cancers from other parts of the body is also the most likely cause of tumours in the epidural space and spinal leptomeninges.

Effective management of symptoms should be a consistent aim throughout the course of the illness, and will become the central aspect of care as recurrences and deterioration occur. It will be important to try to prepare the family for this inevitable terminal stage as early as possible, not spelling out the worst possibilities, but recruiting their interest in reporting changes in affect or function, and helping them feel that they have permission to ask any questions about what lies ahead and about how their coping may be enhanced.