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Brain Tumor.backup

6 min read

Brain Tumor

Dr.Safdar Malik MD FCPS SR Neurosurgery KSU

Lina Serhan

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Background

  • The incidence of CNS tumors ≈ 1% of all cancers.
  • Third leading cause of cancer deaths in people 15 to 34 years of age.
  • Second leading cause of cancer deaths in children.

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Risk Factors

  • Radiation therapy. can cause and can change grading of tumors neurofibromatosis type 1 and 2
  • Genetics; e.g: NF, Tuberous sclerosis, Von Hippel-Lindau synd., Li-Fraumeni syndrome, and Turcot syndrome.
  • Lymphomas that begin in the brain.
  • Male gender (except meningioma, more in females).

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Key

  • Intra Axial the tumor arise from Center eg: Brain Cells tumor < Astrosite - astrocytoma glial cells
  • Extra Axial arise from meninges
    • Tumors In Adult
    • Tumors In Children

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Origin

  • Glial Tissue from brain cells (Glioma, Astrocytoma)
  • MENENGIES meningioma not very common
  • Ependymal Layer Cells which cover Ventricles
  • Choroid plexus Production of CSF it’s in all brain except (Lateral Ventricle) ⇒ Papilloma
  • Bone
  • PNET
  • Glands Brain glands < pituitary adenoma
  • Others

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Location

  • in Pediatric most of tumors is in posterior fossa

  • in adult more in supratentorial

  • Supra Tentorial

  • Infra Tentorial

  • Intra Axial

  • Extra Axial

  • Sellar & Supra Sellar

  • Pineal region

  • Intra Ventricular

  • Cp angle

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the brain metastasis locally specically meniggemia can involve skull bone not to other organs

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*Brain has no lymph nodes so no mel’s in Brain → we don’t use TAM staging system

IIIIIIIVIs there’s only one metastasis called DGP met, IIIIIIIV
Astrocytic tumours
Subependymal giant cell astrocytomabenign↓highly gradedCentral neurocytoma•
Pilocytic astrocytomawe can remove it•completely and no needDr. BalshawayExtraventricular neurocytoma•
Pilomyxoid astrocytoma•Cerebellar liponeurocytoma•
Diffuse astrocytoma•Paraganglioma of the spinal cord•
Pleomorphic xanthoastrocytoma•Papillary glioneuronal tumour•
Anaplastic astrocytoma•Rosette-forming glioneuronal tumour of the fourth ventricle•
Glioblastoma always in Adult•Pineal tumours
Giant cell glioblastoma•Pineocytoma•
Gliosarcoma•Pineal parenchymal tumour of intermediate differentiation••
Oligodendroglial tumoursPineoblastoma in Pediatric•
Oligodendroglioma•Papillary tumour of the pineal region••
Anaplastic oligodendroglioma•Embryonal tumours
Oligoastrocytic tumoursMedulloblastoma•
Oligoastrocytoma•CNS primitive neuroectodermal tumour (PNET)•
Anaplastic oligoastrocytoma•Atypical teratoid / rhabdoid tumour•
Ependymal tumoursTumours of the cranial and paraspinal nerves
Subependymoma•Schwannoma•
Myxopapillary ependymoma•Neurofibroma•
Ependymoma•Perineurioma•••
Anaplastic ependymoma•Malignant peripheral nerve sheath tumour (MPNST)••
Choroid plexus tumoursMeningeal tumours
Choroid plexus papilloma•Meningioma•
Atypical choroid plexus papilloma•Atypical meningioma•
Choroid plexus carcinoma•Anaplastic / malignant meningioma•
Other neuroepithelial tumoursHaemangiopericytoma•
Angiocentric glioma•Anaplastic haemangiopericytoma•
Chordoid glioma of the third ventricle•Haemangioblastoma•
Neuronal and mixed neuronal-glial tumoursTumours of the sellar region
Gangliocytoma•Craniopharyngioma•
Ganglioglioma•Granular cell tumour of the neurohypophysis•
Anaplastic ganglioglioma•Pituicytoma•
Desmoplastic infantile astrocytoma and ganglioglioma•Spindle cell oncocytoma of the adenohypophysis•
Hyperobscoplastic neuroepithelial tumour•7

CBTRUS Statistical Report

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Gliomas (ICD-O-3: 9380-9384, 9391-9460, 9480) account for 29% of all tumors and 80% of malignant tumors

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CONT.

Common 1° neoplasms:

  • Gliomas #1 (50%)
  • Meningiomas #2 (25%)

Among children:

80-90% IN POSTERIOR FOSSA

  • Astrocytomas benign
  • Medulloblastoma
  • Ependymoma

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Signs & Symptoms

  • SYMPTOMS & SIGNS DUE TO RAISED ICP
    • Recurring, persistent, deep, dull headaches.
    • Vomiting. • Dizziness. • Seizures. Papilledema. Bradycardia.

Hypertension

  • SYMPTOMS DUE TO ORIGION OF TUMOR

  • SEIZURES

epilipsy for first time do CT scan

  • Weakness or paralysis, part of the body.

  • Changes in sensory perceptions, such as vision, hearing, touch, taste and smell.

  • Changes in personality and/or thought processes.

  • Cerebellar .

  • Pituitary hormonal imbalance

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Cont.

  • Different lobes of the cerebrum carry out specific tasks.

The frontal lobe is generally where “higher functions” of thought, memory, judgment and movement originate.

The parietal lobe processes sensory information and is involved in orientation and recognition.

The occipital lobe processes visual information.

The temporal lobe is involved in hearing, language, expression and memory.

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Glioma

  • Characteristics
  • Poorly defined
  • Highly agressive in adult
  • Occurs in the white matter of cerebral hémisphères so can occure any site of brain.
  • Spread extremely rapidly

Average age of onset:

  • Fifth decade

General name for several tumors that arise from glial cells:

  • Astrocytes (Glioblastoma multiforme is the most common)
  • Ependymal
  • Oligodendrocytes

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Cont.

  • between the hemispheres: ✓ Seizures, lower extremity weakness, headache, personality changes, dementia, increasing apathy, flattening of affect, unsteadiness, tremor

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Cont.

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intra-axial

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Cont.

Tumors that arise from meninges: arachnoid

Characteristics:

  • grow on the surface of the brain (or spinal cord), and therefore push the brain away
  • Most are considered “benign”
  • slow-growing
  • low potential to spread

meningioma (Extra - acid)

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Cont.

  • Sphenoid Wing :

Eye-bulging, decreased vision, paralysis of eye movement, seizures, memory difficulty, personality change, headache

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Cont.

Symptoms according to location:

  • Surface of the brain:
    • Seizures
    • headache
    • extremity weakness
    • difficulty speaking
    • visual field deficit

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Cont.

  • Olfactory Groove and sella :

Anosmia, subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual impairment.

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CP angle

all benign

  • Schawanoma 8th cr nerve, 5th cr nerve and sometimes 7th vestibuloculture
  • Meningioma
  • Arachnoid Cyst
  • Haemangioblastoma

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CP angle

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Cont.

Cerebellopontine angle:

Loss of hearing, = 8th

Facial muscle weakness, = 7th, 8th dizziness, unsteadiness, incoordination, hydrocephalus, voice and swallowing difficulties.

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Pituitary tumors

→ when it increase in size it press on optic chiasma so pit can’t see temporal side

→ has 2 types: Hypersecretion of hormone remove tumor by Nasal-endoscopic resection Hypersecretion of hormone symptom depend on which hormone

Pituitary Adenomas

Pituitary Carcinomas

Sarcomas

Meningioma

Chardomas

Haemangiblastoma

Cyst

Rathkes Cleft cyst, Arachnoid cyst & Mucoceles. Dermoid & Epidermoid

Craniopharangioma.

Astrocytoma.

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Cont.

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Post Fossa Sol

  • DUE TO ↑ ICP
  • HYDROCEPHALOUS because of obstruction
  • ATAXIA/IMBALANCE
  • CEREBELLER SIGNS

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PFT

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PFT

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First you have to confirm the diagnosis by Histopathology

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Cont.

  • Location of tumor.
  • Radiological appearance of tumor.
  • Size of tumour
  • The risks and potential benefits of available treatment options
  • General health & comorbidities.
  • Age
  • The type of healthcare services available / your ability to travel

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Options

The most common treatment are:

  • Surgery
  • Drug therapy (chemotherapy, immunotherapy, gene therapy) steroid
  • Radiotherapy
  • Combined chemo/radiotherapy
  • Best supportive care
  • Watch and wait

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Cont.

  • Radical: In some cancers the intent is to cure. For brain tumours the aim is to stabilize the disease with best standard treatment which currently is a combination of radiotherapy and oral chemotherapy.
  • Palliative: The intent here is to relieve the symptoms when a cure is not possible. Sometimes it is better to look after the symptoms because to deal with the cause may be too damaging.

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scenario

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Broca’s area located around pars opercularis (44) and pars triangularis (45)

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affect the sperm area

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Gliomas

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Cont.

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Not the same!

Meningioma

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Metastasis

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Glioma

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Graph View