Tumors of nervous system

Research center of neurology Neurosurgical department

Pathologic classification (WHO, 2000)

1.

Neuropithelial tumors
1.1. Astrocytal tumors

1. 2.

1. 2. 3. 4. 5. 6. 7.

1.1.1. Astrocytoma 1.1.2. Anaplastic astrocytoma 1.1.3. Glioblastoma 1.2. Oligodendroglial tumors 1.3. Ependimar tumors 1.3.1. Ependimoma 1.3.2. Anaplastic ependimoma 1.3.3. Mixopapillar ependimoma 1.3.4.Subependimoma 1.4. Mixed gliomas 1.5. Tumors of vascular plexus 1.6. Neuropeithelial tumors 1.7. Neuronal tumors 1.8. Tumors of epiphisis 1.9. Embrional tumors Tumors of brain and spinal nerves Tumors of brain membranes 3.1.1. Meningiomas 3.1.2. Atypic meningiomas 3.1.3. Papillar meningiomas 3.1.4. Anaplastic meningiomas 3.2. Mesenchymal tumors 3.3. Primary melanoma 3.4. Tumors of unknown origin Lymphomas and haemopoetic tumors Herminative tumors Cysts and pseudotumors Tumors of sella turcica Invasive tumors of bones Metastatic tumors Non-classified tumors

Classification of brain tumors

BRAIN TUMORS
1. Intracerebral 2. Intraventricular

3. Extracerebral
4. Intermediate group 5. Independent group

Classification of brain tumors

1. Intracerebral: Astrocytoma Oligodendroglioma Mixed gliomas Ependimal tumors Choroid plexus tumors Neuronal ad neuroglial tumors Embrional tumors Tumors of epiphisis

Classification of brain tumors

2. Intraventricular - Primary: ependimomas choroid papiilomas meningiomas colloid cysts craniopharyngiomas - Secondary: invasion of tumors to the ventricular cavity

Classification of brain tumors

3. Extracerebral Neurinomas Meningiomas Tumors of pituitary gland (adenomas, craniopharyngiomas) Bone tumors (osteomas, hemangiomas, epidermoids, dermoids, chordomas)

Classification of brain tumors

4. Intermediate group dysembriogenetic tumors (embrional, herminative) craniopharyngiomas cholesteatomas dermoid cysts teratomes

Classification of brain tumors

5. Independent group
metastatic

unclear origin haemopoetic tissue tumors invasing of brain cavity cysts vascular pseudotumours reactive and inflammtive pseudotumors

Topographic classification
For brain topography:
intracerebral extracerebral

1.
-

2.
-

For tentorium topography:

supratentorial subtentorial

CLASSIFICATION

Older classification:
So called non-malignant So called malignant

Pathologic criteria: Nuclear atypia Mitosis Necrosis Proliferation (Ki-67!)

Diagnosis
1.

2.
3. 4. 5. 6.

Neurological symptoms CSF tests X-Ray of brain Ophtalmologic symptoms MRI and CT MRI- or CT-angiography

Clinical syndromes of brain tumors: 1) Cerebral hypertension 2) Focal neurological symptoms 3) Occlusion hydrocephalus 4) Dislocation Reasons for hypertension: increasing of intracereral volume peritumoral swelling occlusion hydrocephalus * alteration of vein circulation

Diagnosis Symptoms of brain tumors:

basic focal dislocation signs

Diagnosis
1.

Basic symptoms:

Headache Vertigo Nausea and vomiting Visual disturbances Epilepsy Psychiatric diseases

Diagnosis
2. Focal symtoms

Frontal lobe Precentral gyrus Postcentral gyrus Temporal lobe Parietal lobe Occipital lobe Basal ganglion 3rd ventricle

Diagnosis

3. Dislocation:
Transtentorial inclination Craniovertebral inclination Lateral dislocation

Falx-meningioma

Meningioma of sphenoid bone

Macroadenoma of pituitary gland

Craniopharyngeoma

Craniopharyngeoma of 3rd ventricle. Obstructive hydrocephalus.

Tumor of basal ganglion. Obstructive hydrocephalus.

Recklinghausen disease

Lymphoma

Lymphoma (DO NOT OPERATE!)

Metastatic tumors

Angioreticuloma

Karnovski scale (oncology)

Condition
No complains Non-significant symptoms Normal activity needs extra-force, but still self-care Needs extra-force from relatives, but some kinds of self-care is posible Incapacity. Needs significant aid. Needs special aid, including medical help Should be admitted to the hospital Health condition critical. Needs intensive care. Serious risk of death Death

Scale ,%
100 90 80 70 60 50 40 30 20 10

Surgical treatment
Surgical removal: total, subtotal, biopsy. Depends on the nature and location of tumor.
Syrgical approach craniotomy. Stereotaxic biopsy for tumors of unknown origin, before chemotherapy and radiotherapy.

Radiotherapy
Radiotherapy is important method for mos patients with gliomas. Standard protocol for radiotherapy after the removal of glioma: +2 cm around the removed tumor; Dose 55-60 Gr for 25-30 fractions, time of treatment - 5-6 weeks.

Chemotherapy

Nidran (ACNU), Carmustin (BCNU), Lomustin (CCNU, CeNU), Mustofuran (PCNU).

Radiosurgery of brain surgery

Stereotaxic radiosurgery Gamma-knife Cyber-knife

SPINAL CORD TUMORS

Primary
intramedullary extramedullary

Secondary
Invasion of vertebral tumors into spinal

canal

SPINAL CORD TUMORS

Intramedullary tumors:
Ependimomas Astrocytomas Multiformis spongioblastomas Medulloblastomas Oligodendrogliomas

SPINAL CORD TUMORS

Extramedullary tumors:
neurinomas meningiomas hemangioblastomas lipomas

SPINAL CORD TUMORS

Clinical features:
1. 2. 3.

Radicular stage Brown-Seckar syndrome Total axial alteration of spinal cord

Topography of spinal cord tumors

Removal of intramedullary tumor

Intramedullary tumor

Intramedullary tumor

Myelotomy for removal of intramedullary tumor

Removal of intramedullary tumor

Recklinghausen disease

Arachnoid cyst

Chiari malformation

Syringobulbia

POSTERIOR FOSSA TUMORS

Astrocytomas of cerebellum Hemangioblastomas Medulloblastomas Ependimomas Choroidpapillomas Gliomas of brainstem Neurinomas of acoustic nerve Meningiomas Chordomas Glomus tumors of jugular vein

CONTACTS

ANY PROBLEMS WITH SPINE / NEUROSURGERY

Alexey Kascheev, MD, neurosurgeon +7-903-573-54-96 kasch@hotbox.ru Facebook.com: Alexey Kascheev