BRAIN TUMOR

• Incidence – 6 / Lac
• 25% Metastatic.
• Children – 1 in every 12 patients.
• SITE – ADULT – 80% Supratentorial
20% Infratentorial
CHILDREN – 40% Supratentorial
60% Infratentorial.
• MC tumors – GLIOMA
MEDULLOBLASTOMA
METASTASIS
CLASSIFICATION

WHO CLASSIFICATION BASED ON THE TISSUE OF ORIGIN

• NEUROEPITHELIAL
1. Astrocytoma ( Astrocytes)
2. Oligodendroglioma (Oligodendrocytes)
3. Ependymoma (Ependymal cells)
4. Ganglioglioma / Neurocytoma (Neurons)
5. Pineocytoma (Pineal gland)
• EMBRYONAL CELL
Medulloblastoma
• MENINGES
Meningioma
• NERVE SHEATH
1. Schwannoma
2. Neurofibroma
• BLOOD VESSEL
Hemangioblastoma
• GERM CELL
1. Germinoma
2. Teratoma
• SELLA
1. Craniopharyngioma
2. Pituitary Adenoma
• METASTATIC
GENERAL C/F

• MASS EFFECT AND RAISED ICT

Headache and vomiting
Papilledema
Brain herniation – tentorial and cerebellar Tonsillar.
Brain shift.
• EPILEPSY
Generalised
Partial – Motor tonic or clonic
Sensory – numbness or tingling in face or limbs
Complex partial (Temporal) – Hallucinations, abnormal taste, fear
Pure visual
• FRONTAL LOBE
1. Face, arm and leg weakness.
2. Expressive aphasia.
3. Personality changes.
• PARIETAL LOBE
1. Altered senses – touch, two point discrimination, astereognosis.
2. Agnosia, acalculia, agraphia and R/L confusion.
3. Hemineglect
• OCCIPITAL LOBE
Visual field defects and Homonymous hemianopia.
• TEMPORAL LOBE
1. Receptive aphasia
2. Visual field defects
• BRAINSTEM
1. Cranial nerve palsy
2. Long tract signs
3. Altered consciousness.
4. Ophthalmoplegia.
5. Pupillary defects
• CEREBELLUM
Ataxia / Nystagmus / Vertigo / Dysmetria / Dysarthria
ASTROCYTOMA

• MC primary brain tumor (80%)

• Grows from star shaped astrocytes that
are supporting cells of the CNS.
• 4 grades
• Glioblastoma – most malignant grade
• 4th to 6th decade.
• Location – Cerebral hemispheres in adult
Cerebellum in children.
• Rare childhood Hypothalamic
astrocytoma presents with Obesity and
Diabetes insipidus.
• Low grade astrocytoma can be
effectively treated with surgery alone
• High grade astrocytoma are difficult to
excise completely
• Treated with Steroids
Surgery
Post operative Chemotherapy
Post operative Radiotherapy
 OLIGODENDROGLIOMA
• Presents in 4th to 5th decade with
Seizures.
• Usually in the Frontal lobe and
Temporal lobe.
• Low grade is treated by surgery
• High grade with Surgery and
combination Chemo and
Radiotherapy.
EPENDYMOMA
• Arise from Ependymal cells in the 4th
ventricle and Choroid plexus.
• Childhood tumor - 1st and 2nd decade
of life.
• Spreads via the CSF.
• Posterior fossa Ependymoma presents
with Obstructive hydrocephalus.
MENINGIOMA

• Arises from the Arachnoid granulation

and remains attached to the Dura.
• Well demarcated and easily seperable.
• May arise from anywhere in the
meninges.
• Highest concentration around venous
sinuses.
• 4th -6th decade
• Seizures
• Raise ICT and Headache
• Focal neurological signs
C/F OF MENINGIOMA

DEPENDS ON THE SITE OF ORIGIN

• Parasagittal and parafalcine – motor and sensory loss in the leg and foot area in
the Pyramidal pattern.
• Deep in the Falx – B/L leg weakness.
• Posterior occipital – B/L Homonymous hemianopia.
• Frontal – Personality changes and dementia.
• Olfactory groove – B/L anosmia.
TREATMENT
Complete surgical removal is the treatment of choice
MEDULLOBLASTOMA

• Highly malignant childhood tumor of

< 10 years.
• Arise from the cerebellum and extend
into the 4th ventricle.
• Truncal and gait ataxia over weeks.
• Raised ICT.
• Surgery followed by Radiotherapy and
chemotherapy is the treatment of
choice.
• Prognosis is poor.
VESTIBULAR SCHWANNOMA

• Arise from the vestibular part of VIIIth

cranial nerve.
• Benign and very slow growing.
• Lie in the Cerebro-pontine angle.
• Usually in the 4th to 5th decade
• B/L in Neurofibromatosis.
• C/F – triad of 1. Progressive
sensorineural deafness.
2. Vertigo.
3. Tinnitus.
 C/F cont.
• Hydrocephalus and raised ICT –
compression of 4th ventricle.
• IX th CN – dysphagia
• X th CN – Hoarseness of voice
• XI th CN – Palatal weakness.
• Cerebellar features
• Hemiparesis.
• Facial weakness – uncommon.