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Brain tumors remain a challenge to understand, diagnose and treat.Nevertheless the last twenty years have seen advances in basic science, diagnostic imaging, surgery, chemo therapy and radiation therapy.In the area of basic science new techniques in molecular biology have lead to a better understanding of the pathogenesis of brain tumors and led to novel strategies for therapeutics.These techniques include molecular profiling, microRNAs, epigenetics and nanotechnology.High-throughput sequencing technologies allowed glioblastoma multiforme (GBM;a highly malignant brain tumor) to be one of the first human cancers to be sequenced.This improved understanding of brain tumor biology has led to practical applications: the use of l p and 19q chromosomal analysis to help predict the behaviour of oligodenroglioma (another type of brain tumor) and its response to chemotherapy;the use of MGMT methylation status in GBM to identify a subgroup of patients that may have a better survival;the ability to subdivide medulloblastoma (a paediatric brain tumor) into four distinct groups based on molecular profiling (each with a different clinical behaviour).The diagnosis and response to treatment of brain tumors has been improved by advances in diagnostic imaging.These include advances in computerized tomography (CT) scanning, magnetic resonance imaging (MRI), positron emission tomography (PET) scanning and magnetic resonance spectroscopy.International criteria (RANO-response assessment in neuro-oncology) are being developed to standardize response assessment in patients globally.Advances in neurosurgery now allow maximal safe resection of brain tumors in patients.These advances include the operating microscope, neuronavigation (image guidance technologies), awake craniotomy, 5-ALA tumor marking, and intra-operative MRI.Chemotherapy options have improved for patients.International multi-center clinical trials have led to the adoption of drugs such as temozolomide for GBM, with improved patient outcomes.A better understanding of brain tumor angiogenesis, invasion and signal transduction has led to the development of agents that target these tumor pathways.Radiation therapy has seen advances in the ability to deliver radiation more precisely and with fewer side effects for the patient.Techniques include stereotactic radiosurgery and conformal radiation therapy.This presentation will summarize advances in brain tumor understanding, diagnosis and treatment.