A neurologist or neurosurgeon often needs to evaluate the patient. Although an excellent tentative location can be suggested on the basis of a careful history (from the family as well as the patient) and neurologic evaluation, CT and MRI scans will usually confirm the suggested location. These scans are also used by the neurosurgeon and radiation oncologist to plan treatment. Physical Examination • As well as a complete neurologic examination, specific tests such as visual field determinations and hearing tests are sometimes useful. Blood and Other Tests • Routine blood tests will be performed as a baseline. • Some tumors secrete substances that can be measured in the blood and cerebrospinal fluid (CSF). This fluid is removed by lumbar puncture (spinal tap), a procedure similar to spinal anesthesia. CSF may also be examined for malignant cells from tumors that have a tendency to spread from the brain into the spinal cord or its covering. A lumbar puncture may be risky when there is increased intracranial pressure. This risk has been largely removed now that CT or MRI scans can determine if there is enlargement of the fluid cavities within the brain (ventricles) or major pressure shifts within the brain.