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Emerging diagnostic tools, such as liquid biopsies, and therapeutic strategies leveraging extracellular vesicles (EVs) are reshaping the field of neuro-oncology. EVs, lipid bilayer-enclosed particles secreted by cells, carry oncogenic cargo such as microRNAs and molecular chaperones, influencing tumor progression, immune evasion, and therapy resistance. Recent research highlights their potential as biomarkers for early diagnosis and vehicles for targeted drug delivery across the blood\u2013brain barrier (BBB). EV-based nanotherapeutics show promise in improving treatment precision, reducing systemic toxicity, and advancing precision medicine in brain tumor management. However, challenges related to EV heterogeneity, cargo-loading efficiency, and large-scale production must be addressed to fully realize their therapeutic potential. This review explores the multifaceted roles of EVs in brain tumors, emphasizing their diagnostic, prognostic, and therapeutic applications.<\/jats:p>","DOI":"10.3390\/ijms262411826","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:21:43Z","timestamp":1765182103000},"page":"11826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Emerging Frontiers in Neuro-Oncology: Insights into Extracellular Vesicle-Driven Tumor Mechanisms and Nanotherapeutic Strategies"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6927-403X","authenticated-orcid":false,"given":"Tommaso","family":"Colangelo","sequence":"first","affiliation":[{"name":"C.R.E.A.T.E.\u2014Center for Research and Innovation in Medicine, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"},{"name":"Unit of Cancer Cell Signalling, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2361-7045","authenticated-orcid":false,"given":"Anna Alessia","family":"Saponaro","sequence":"additional","affiliation":[{"name":"C.R.E.A.T.E.\u2014Center for Research and Innovation in Medicine, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"},{"name":"Unit of Cancer Cell Signalling, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3535-7635","authenticated-orcid":false,"given":"Gianluigi","family":"Mazzoccoli","sequence":"additional","affiliation":[{"name":"Chronobiology Laboratory, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6424-7841","authenticated-orcid":false,"given":"Gaetano","family":"Serviddio","sequence":"additional","affiliation":[{"name":"C.R.E.A.T.E.\u2014Center for Research and Innovation in Medicine, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"},{"name":"Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9875-019X","authenticated-orcid":false,"given":"Rosanna","family":"Villani","sequence":"additional","affiliation":[{"name":"C.R.E.A.T.E.\u2014Center for Research and Innovation in Medicine, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"},{"name":"Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Vitale, A.M., Santonocito, R., Vergilio, G., Marino Gammazza, A., Campanella, C., Conway de Macario, E., Bucchieri, F., Macario, A.J.L., and Caruso Bavisotto, C. 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