BRAIN TUMORS

CNS Tumours can be

• Benign or malignant
• However almost all brain tumors considered as malignant since they
result in death if not treated
Incidence
• 2% of all cancer deaths
• 20% of all childhood malignancies
• 20 per 100,000 in late adulthood
• Mortality rate 5 per 100,000
Classification
• Based on cell of origin
• Over 50% neuroepithelial
• 15% metastatic
• 15% meningiomas
• 8% pituitary tumors
WHO Classification of BrainTumors
• Neuroepithelial tumors
• Gliomas:
• Astrocytomas
• Oligodendrogliomas
• Ependymoma
• Choroid plexus tumor
• Pineal tumors
• Neuronal Tumors
• Ganglioglima
• Gangliocytoma
• Neuroblastoma
• Medulloblastoma
Classification contd..

• Nerve sheath tumor

• Acoustic neuroma
• Meningeal tumors
• Meningioma
• Pituitary Tumors
• Germ cell tumor
• Germinoma
• Teratoma
• Lymphomas
• Metastatic Tumors
Classification contd..

• Tumor like malformations

• Craniopharyngioma
• Epidermoid tumor
• Dermoid tumor
• Colloid cyst
• Contiguous extension from regional tumors, eg glomus tumor
Types
Aetiology
• Not clearly understood
• No genetic predisposition
• Chromosomal abnormalities noted in many CNS tumors
• Immunosuppression: Increase incidence of CNS lymphoma
• Loss of tumor suppressor genes and addition of oncogenes to genome
eg; mutation in p53 tumor suppressor gene in astrocytoma and
meningiomas
Clinical features
• As a result of one or a combination of
• Raised ICP
• Focal neurological signs
• Organic mental changes
• seizures
C/F:
• Severe headache a/w nausea and vomiting
• Headache progressive
• Vision disturbance d/t papilledema
• Focal neurological signs related to area of cortex involved
• C/L signs with lesions in posterior frontal region(motor) or anterior
parietal lobe (sensory)
• Tumor in dominant hemisphere- aphasia
• Tumor in nondominant hemisphere- apraxia
C/F
• Optic pathway involved: visual symptoms
• Temporal lobe: focal seizures with auras and visual field defects
• Tumors in frontal lobe can grow to considerable size before presenting
with symptoms (altered cognitive function and personality changes)
• Subfrontal region- olfactory nerve involved, anosmia
• Sellar and suprasella- visual field and acuity problems
• Tumors in relation to ventricular system: hydrocephalus
• Brainstem and CP angle- cranial nerve palsies
• Cerebellum- incoordination and nystagmus

• The presence of systemic symptoms such as malaise, weight loss,

anorexia, or fever suggests a metastatic rather than a primary brain
tumor.
Age Cerebral Intrasellar and Posterior fossa
hemisphere paresellar

Childhood and Ependymomas Astrocytomas Astrocytoma

adolescence Astrocytomas Mixed gliomas Medulloblastoma
Ependymomas Ependymoma

Age 20-40 Meningioma Pituitary adenoma Acoustic neuroma

Astrocytoma Meningioma Meningioma
Metastatic tumors Metastatic tumors

>40 Glioblastoma Pituitary adenoma Metastatic tumors

multiforme Meningioma Acoustic neuroma
Meningioma meningioma
Metastatic tumors

Frequency of brain tumors according to age and site

 Diagnosis
• Neurological examination

• Optic nerve examination

• CT scan

• Magnetic resonance imaging (MRI)

• Angiogram
Treatment:
• Glucocorticoids decrease the volume of edema surrounding brain
tumors and improve neurologic function;
dexamethasone (initially 12–20 mg/d in divided doses PO or IV) is
used.
• Anti epileptics.
• Specific treatment involves- Surgery, radiotherapy and chemotherapy
Gliomas
• 50% of adult intracranial tumors
• Usually supratentorial
• Neuroectodermal origin arising from glial cells which are
• Astrocytes
• Oligodendrocytes
• Ependymal cells
• Neuroglial precursors
• Astrocytoma, most frequent
• Prognosis depend on grading
• Rarely metastasise
Gliomas
• Investigations:
• CT/CEC
• MRI

• Treatment:
• Surgery and radiotherapy
• Chemotherapy
Metastatic tumors
• 15% of intracranial neoplasms
• Common sites of origin are
• Lung (20%), breast(20%), melanoma(11%)
• Kidney(11%), colon, unknown
• Show well on CECT
• Steroids help reduce peritumor edema
• Surgery approproiate in solitary surgically accessible lesion
• Radiotherapy
Meningiomas
• 15% of intracranial neoplasms
• Most common benign neoplasms
• Uncommon in children
• Female>male
• More in middle age
• Originate from meningoendothelial cells, occur in abundance in
arachnoid villi hence site of occurence
• Locations:
• superior sagittal sinus
• over free convexity and falx
• along sphenoid wind
• beneath frontal lobes
• within posterior fossa
• Derive blood supply from external carotid circulation
• Surgical t/t: if possible complete excision
• Subtotal excision: 40% show progressive growth
Nerve sheath tumors
• Benign tumors originating from schwann cells
• Have predilection for sensory nerves esp. eighth nerve ( acoustic
schwannoma)
• Followed by fifth nerve
• Acoustic schwannoma expands into internal auditory canal and
extends into CP angle compressing pons, cerebellum and cranial
nerves
• Surgical intervention aimed at total excision preserving neurological
function
Pseudotumor cerebri
• Benign intracranial hypertension
• Syndrome characterized by increased ICP
• Absence of neurological manifestations other than headache or
papilledema
• Follows ear infections
• May be associated with thrombi in superior longitudional or lateral sinus
• Endocrine disorders, horomone or drug therapy
• Prognosis good
• Complete recovery delayed for months or years
And again…
• You are most welcome!!!!!!!!!!!!!!!!