Brain tumors

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Brain tumors
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Incidence of tumors

• 10-25 per 100.000 population per year
• 5-15 among all tumors

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Classification of brain tumors

• Tumors of neuroepithelial tissue
• Astrocytic tumors
• Oligodendroglial tumors
• Ependymal tumors
• Mixed gliomas
• Choroid plexus tumors
• Neuronal and mixed neuronal-glial tumors
• Pineal parenchymal tumors
• Embrional tumors

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Classification of brain tumors

• Tumors of cranial and spinal nerves
• Tumors of the meninges
• Tumors of meningothelial cells
• Mesenchymal nonmeningothelial tumors
• Primary melanocytic lesions
• Tumors of sellar region
• Germ cell tumors
• Lymphomas and hemopoietic neoplasms
• Cysts and tumor-like lesions
• Local extentions from regional tumors
• Metastatic tumors
• Unclassified tumors

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Surgical classification of brain tumors

• Intracerebral
• Intraventricular
• Extracerebral
• Supratentorial
• Infratentorial
• Exact localization (lobes, basal ganglia, brain
  stem, ventricles)

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Clinical presentations

• Symptoms due to increased intracranial pressure
• Headache
• Vomiting
• Seizures
• Alteration of cognitive functions
• Symptoms due to local dysfunction
• Neurological deficit
• Seizures
• Meningeal signs
• Endocrine symptoms
• Dislocation (herniation) syndromes

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Diagnostic procedures

• X-ray examination
• CT with and without contrast
• MRI
• Angiography

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Treatment

• Surgical
• Total and subtotal removal
• Partial removal
• Palliative surgery (Decompresive trepanation,
  shunting)
• Radiation
• Distant hamma-therapy
• Radiosurgery (Hamma-knife, linear accelerator)
• Chemotherapy
• Hormonoterapy for meningiomas
• Nitrosoureas, vincristine, cyclophosphamide, oth
• Symptomatic conservative treatment
• Anti-edema dexametazone, lasics
• Seizure medicines
• Narcotic analgetics

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• teratoma.

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• Glioblastoma multiforme

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• large orbital optic glioma in 5-year-old child
  with neurofibromatosis type 1.

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• Germinoma of the pineal region obstructing the
  third ventricle and causing hydrocephalus.

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• choroid plexus papilloma.
• After contrast medium administration, the tumor
  enhanced homogeneously. The vascular pedicle
  leading to the tumor is well appreciated

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• Preoperative image made without (A) and with (B)
  gadolinium enhancement shows fourth-ventricular
  invasion of an ependymoma in a child.
• C. gadolinium-enhanced image shows the tumor
  protruding from the foramen of Luschka into the
  cerebellopontine angle on the right.
• D. image made postoperatively confirms complete
  resection

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• Postcontrast computed tomography showing
  relatively homogeneous enhancement in
  medulloblastoma.

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• Computed tomography of a tumor presenting with
  acute hemorrhage.
• anaplastic mixed oligoastrocytoma.

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• A. noncontrast-enhanced CT scan of a cystic
  craniopharyngioma This large tumor is almost
  isodense with the surrounding brain tissue and is
  poorly defined. Two calcified areas on the left
  side of the cyst wall are seen, suggesting the
  diagnosis.
• B. Axial scan following contrast enhancement. The
  tumor is well defined, and the cyst wall and
  calcifications are seen.

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• Coronal T1-weighted magnetic resonance images
  show a parasagittal malignant meningioma (left)
  and its recurrence (right) 8 months after gross
  total resection and external beam radiation
  therapy.

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• Vestibular schwannoma

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• The lower clival meningioma.
• This 53-year-old woman presented with progressive
  quadriparesis and left-sided glossopharyngeal,
  vagal, accessory, and hypoglossal nerve palsies.

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• Gyri involved by this infiltrating astrocytoma
  are pale, wide, and flat. en bloc resection of a
  tumor
• Internal decompression of an infiltrative tumor.

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• Surface presentation of an intraparenchymal
  tumor.

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Hamma-knife
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Spinal cord tumors
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Surgical classification

• Intramedullary
• Extramedullary
• Level (cervical, thoracic, lumbar)

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Histological classification

• Glial
• Astrocytomas
• Ependimomas
• Nerve sheath tumors
• Neurinoma
• neurofibroma
• meningiomas

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Clinical presentations

• Segmental neurological deficit
• Conduction neurological deficit
• Ascending
• Descending
• Pain

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Additional methods of diagnosis

• MRI
• Postmyelography CT
• Angiography

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• Extramedullary tumor on the C1-C2 level
  (meningioma)

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• neurinoma

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• Intrmedulary tumor

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Treatment

• Surgical
• Radiation
• For malignant gliomas