In our last episode, we mastered the management of non-functioning pituitary adenomas, where the primary goal of radiation is long-term tumor control. Today, we tackle the more complex world of functional, or secreting, pituitary adenomas. Here, the clinical challenge is entirely different. Our goal is not just to control the size of the tumor, but to achieve biochemical control—to shut down the hormonal overproduction that causes debilitating syndromes like Cushing's disease and acromegaly. This episode will master the distinct, subtype-specific management of these tumors, focusing on their unique goals, the higher radiation doses required, and the differing timelines for hormonal normalization.

In our last two episodes, we mastered the management of vestibular schwannomas. Today, we shift our focus to another common sellar region tumor: the pituitary adenoma. While often discovered incidentally, these tumors can cause significant morbidity through mass effect. In this episode, we will focus specifically on non-functioning pituitary adenomas, covering their comprehensive workup, surgical management, the critical role of adjuvant radiation, and the evidence-based outcomes and toxicities.

In our last episode, we established the foundational framework for managing vestibular schwannomas. We worked up our patient, a 55-year-old man with a Koos Grade II tumor and serviceable hearing, and after reviewing the options, decided that stereotactic radiosurgery offered him the best balance of tumor control and functional preservation. Today, we take him to the treatment planning system. This episode is a deep dive into the technical aspects of radiation for vestibular schwannoma, covering simulation, precise dose prescriptions, critical cranial nerve dose constraints, and long-term follow-up.

Today we're tackling one of the most common non-malignant brain tumors you will treat: the vestibular schwannoma, also known as an acoustic neuroma. While histologically benign, these tumors can cause significant, life-altering morbidity by affecting hearing, balance, and facial function. The management is a masterclass in shared decision-making, balancing excellent tumor control rates against the critical goals of preserving cranial nerve function and quality of life. This episode will lay the complete foundation for managing these tumors, covering the detailed workup, classification, natural history, and the initial decision-making framework.

This is Episode 17b: Non-Glioma Part 2: Atypical & Anaplastic Meningiomas & Future Directions.In Episode 17a, we built the essential foundation for understanding meningiomas, covering their epidemiology, detailed WHO grading, and the management of WHO Grade I tumors. Today, we confront the more challenging and clinically critical aspects: the complex management of Atypical (Grade II) and Anaplastic (Grade III) meningiomas. We will dissect the nuances of adjuvant radiation for these higher-grade tumors, explore strategies for re-irradiation, provide specific radiation planning pearls, and look at the landscape of emerging systemic therapies.

This is Episode 17a: Non-Glioma Part 1: Meningioma Foundations & Grade I Management. While gliomas often take the spotlight, the single most common primary intracranial tumor you will encounter is the meningioma. But don't let its often-benign histology fool you; the management of meningiomas is deceptively complex, nuanced, and surprisingly lacking in high-level randomized evidence. Today, we will build a robust framework for managing these tumors, integrating the latest molecular insights. We'll differentiate WHO grades with precision, apply the classic Simpson surgical grades to predict recurrence, detail the comprehensive workup, and then dive into the evidence-based management of WHO Grade I tumors.

In our last episode, we laid the complete foundation for managing spinal metastases. Today, we transition from the broad strokes of conventional palliation to the high-precision, high-impact world of Stereotactic Body Radiation Therapy, or SBRT. This episode is a practical workshop. We will cover who to treat with SBRT, a deep dive into the conflicting evidence, how to delineate targets with a step-by-step guide, what critical dose constraints to respect, and finally, how to safely approach the challenge of re-irradiation.

In Episode 15a, we covered the comprehensive workup for a patient with suspected spinal metastases, from distinguishing pain types to detailed imaging interpretation and initial supportive care. Today, we move to the definitive decisions. We will master the assessment of spinal stability using the SINS score, delineate the Bilsky scale for grading cord compression, and define the evidence-based management of malignant epidural spinal cord compression, including the landmark Patchell trial and modern conventional RT options.

This is Episode 15a, the first in our new two-part foundational series on Spinal Metastases. Today's episode is titled: "Spine Mets Part 1: Anatomy & Initial Workup."Metastatic disease to the spine is one of the most common and challenging scenarios we face. It can cause debilitating pain, catastrophic neurologic injury, and profoundly impact quality of life. Correct management requires a rapid, systematic approach, and that starts with an impeccable understanding of spinal anatomy and how to interpret imaging. Today, we will build that foundation. We will cover the complete workup, from clinical presentation and imaging to the indications for biopsy. We’ll also refresh our knowledge of essential spinal anatomy, including how to reliably count vertebral levels and ribs on imaging.

This is our mock oral boards for lower GI malignancies. I will present two comprehensive rectal cancer cases, walking you through each one from initial presentation all the way through treatment and follow-up. For each section, I want you to pause and formulate your own structured response before I walk you through the model answer and a key teaching pearl. The goal is to think like an attending and solidify your clinical decision-making from start to finish. Let's get started.