Eligibility Criteria:
Inclusion Criteria:
* Patient must be able to understand and be willing to sign a written informed consent document
* Participant must be willing to comply with study and/or follow-up procedures
* Karnofsky performance status \>= 70%
* Life expectancy of \>= 3 months
* Histologically-confirmed diagnosis of a grade III or IV glioma (including glioblastoma, anaplastic astrocytoma, gliosarcoma, anaplastic oligodendroglioma, or anaplastic oligoastrocytoma), or has a prior, histologically-confirmed, diagnosis of a grade II glioma and now has radiographic findings consistent with a high-grade glioma (grade III or IV)
* Imaging studies show evidence of recurrent tumor(s); if a patient is going to be enrolled to dose level two or higher, the patient must have a component of supratentorial disease (so as to enable placement of a Rickham reservoir/catheter) that is amenable to resection or biopsy
* High-grade glioma has recurred or progressed after prior treatment with brain radiation and temozolomide
* Participant must be in need of a craniotomy for tumor resection or a stereotactic brain biopsy for the purpose of diagnosis or differentiating between tumor progression versus treatment-induced effects following radiation therapy +/- chemotherapy
* Based on the neurosurgeon?s judgment, there is no anticipated physical connection between the post-resection tumor cavity and the cerebral ventricles
* Neurosurgeon finds the prospective participant is able to undergo neurosurgery
* Any number of prior therapies is permitted; from the start of study treatment, the following time periods must have elapsed: 6 weeks from nitrosourea-containing chemotherapy, 4 weeks from non-nitrosourea-containing cytotoxic chemotherapy (except 23 days from last daily dose of temozolomide taken in a 5 of 28 day regimen), and 2 weeks from last dose of a targeted agent (except 4 weeks for bevacizumab); there is no time period requirement for prior radiation therapy
* Any clinically significant toxicity from prior therapy must have improved to grade 0 or grade 1
* Absolute neutrophil count (ANC) \>= 1,500 cells/ul
* Platelets \> 100,000 cells/ul
* Total bilirubin =\< 2.0 mg/dl
* Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) =\< 4 times institutional upper limit of normal
* Serum creatinine =\< 1.5 x the institutional upper limit of normal
* Homozygous negative for the UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT 1A1)\*28 allele
* Absence anti-human leukocyte antigen (HLA) antibodies specific for HLA class I antigens expressed by the coagulation factor III (thromboplastin, tissue factor) (F3).cytosine deaminase (CD).carboxylesterase (CE) NSCs
* Negative serum pregnancy test (women of childbearing potential only)
* Agreement by females of childbearing potential and sexually active males to use an effective method of contraception while participating in this study; women of childbearing potential must have a negative pregnancy test \< 2 weeks prior to registration
Exclusion Criteria:
* Prior therapy with neural stem cells
* Use of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inducers including hepatic enzyme-inducing anticonvulsants (phenytoin, fosphenytoin, carbamazepine, phenobarbital, primidone, oxcarbazepine) within 2 weeks prior to start of study treatment
* Use of moderate to strong CYP3A4 inhibitors within 2 weeks prior to start of study treatment
* Use of drugs known to inhibit UGT1A1, such as atazanir, gemfibrozil, indinavir, or ketoconazole, within 2 weeks prior to start of study treatment
* Co-medication that may interfere with study results; e.g. immuno-suppressive agents other than corticosteroids, such as systemic cyclosporine and tacrolimus; consult principal investigator for questions, including necessary washout period for the specific drug
* Flucytosine within 2 weeks prior to start of study treatment
* Use of herbal medications
* Current use (or planned use during the treatment period) of other investigational agents, or biological, chemotherapy, radiation or other anti-tumor therapy
* Patient has known human immunodeficiency virus (HIV) or hepatitis C infection; baseline testing for HIV or hepatitis C is not required
* Prospective participant is unable to undergo a magnetic resonance imaging (MRI) with contrast agent
* Known chronic or active viral infections of the central nervous system (CNS)
* Clinically significant uncontrolled illness
* Active infection requiring antibiotics
* Diagnosis of Gilbert?s disease
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to irinotecan
* Known sensitivity to any of the products to be administered during dosing
* Any other active malignancy
* Pregnant women and women who are lactating
* Serious medical or psychiatric illness that could, in the investigator?s opinion, potentially interfere with the safety monitoring requirements and completion of treatment according to this protocol
* Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)