INTRACRANIAL

TUMOURS
PRESENTED BY
I.VIDHYA MEHTA
II.VINNY AHUJA
III.GARIMA SABARWAL
IV.ABHA SHARMA

GUIDED BY
DR.ZAFAR SHEIKH
INTRODUCTION
Intracranial tumours or brain tumours are collection
or mass of abnormal cells in brain.

When most normal cells grow old or get damaged ,

they die and new cells take their place. Sometimes ,
this process goes wrong. New cells form and body
doesn’t need them and old or damaged don’t die as
they should. The buildup of extra cells often forms a
mass of tissue called tumour
INCIDENCE
Primarily brain tumors occur in approximately 6
persons per 100000 per year.

25% of patients are estimated with malignancy or cns

metastasis.

About 1 in 12 primary brain tumors occur in

children under 15 years
AEITIOLOGY
GENETIC FACTORS
Normal cell growth and diffrentiation controlled by-
proto-oncogens  expressions altered  oncogenes
alters encoded proteins transforming cell into
malignant state.

Inactivation of expression of tumour suppressor

genes.

Over expression of genes controlling growth factor.

Aeitiology (contd)
CRANIAL IRRADIATION-
Long term follow-up of patients undergoing whole
head irradiation for treatment of tinea capitis and
childhood leukemia shows an increased incidence of
both benign and malignant tumours- eg. Astrocytoma,
meningioma

IMMUNOSUPPRESSION-
Increased incidence of lymphoma.
PATHOLOGY
Intracranial tumors are often described as benign or
malignant.
A benign intracranial tumour may have devastating
effects if allowed to expand within the rigid confines of
the skull cavity. A benign astrocytoma may infiltrate
widely throughout brain tissue preventing complete
removal, or may occupy a functionally critical site
preventing even partial removal.
A malignant intracranial tumour implies rapid growth,
poor differentiation, increased cellularity, mitosis,
necrosis and vascular proliferation.
PATHOLOGICAL CLASSIFICATION
This classification is based on
CELL of origin.
NEUROEPITHELIAL-
 CELL TUMOUR
Astrocytes Astrocytoma
Oligodendrocytes Oligodendroglioma
Ependymal cells Ependymoma
Neurons Neurocytoma
Pineal cells Pineocytoma
EMBRYONAL CELL ORIGIN
Primitive neuroectodermal tumours(PNET)
Medulloblastomas

MENINGES
Meningioma
Meningeal sarcoma

NERVE SHEATH CELLS

Schwannoma
Neurofibroma
BLOOD VESSELS
Haemangioblastoma

GERM CELLS
Germinoma
Teratoma

TUMOURS OF THE SELLAR REGION

Craniopharyngioma
Pitutary adenoma

CYST AND TUMOUR LIKE CONDITIONS

Epidermoid /dermoid cyst
Colloid cyst

OTHER TUMOURS
CHONDROMA
CHONDROCYTOMA
CYLINDROMA
 CLASSIFICATION—
ACCORDING TO SITE
1)CEREBRAL HEMISPHERES
2)HYPOTHALAMUS
3)VENTRICULAR SYSTEM
4)SELLAR/SUPRASELLAR REGION
5)SKULL BASE AND SINUSES
6)POSTERIOR FOSSA
7)PINEAL REGION
 I.CEREBRAL HEMISPHERES

A)EXTRINSIC->
1)MENINGIOMA
2)CYSTS {Dermoid,epidermoid,arachnoid}

B)INTRINSIC->
1)ASTROCYTOMA
2)GLIOBLASTOMA
3)OLIGODENDROGLIOMA
4)GANGLIOGLIOMA
5)METASTASIS
6)LYMPHOMA
II.HYPOTHALAMUS  1) ASTROCYTOMA

III.VENTRICULAR SYSTEM 
1)COLLOID CYST
2)CHOROID PLEXUS PAPILLOMA
3)EPENDYMOMA
4)GERMINOMA
5)TERATOMA
6)MENINGIOMA
7)PINEOCYTOMA/BLASTOMA
8)ASTROCYTOMA
 IV. SELLAR/SUPRASELLAR REGION

1)PITUITARY ADENOMA

2)CRANIOPHARYNGIOMA

3)MENINGIOMA

4)OPTIC NERVE GLIOMA

5)EPIDERMOID/DERMOID CYST
 V. SKULL BASE AND SINUSES

1)CARCINOMA—Carcinomatous meningitis

2)CHORDOMA

3)GLOMUS JUGULARE TUMOUR

4)OSTEOMA
 VI. POSTERIOR FOSSA
A)EXTRINSIC

1)SCHWANNOMA
2)MENINGIOMA
3)EPIDERMOID/DERMOID CYST
4)ARACHNOID CYST
5)METASTASIS

B)INTRINSIC

1)METASTASIS
2)HAEMANGIO BLASTOMA
3)MEDULLOBLASTOMA
4)ASTROCYTOMA
 VII. PINEAL REGION

1)EPENDYMOMA
2)GERMINOMA
3)TERATOMA
4)MENINGIOMA
5)PINEOCYTOMA/BLASTOMA
6)ASTROCYTOMA
 CLINICAL FEATURES
Symptoms tends to develop
insidiously,gradually progressing over
few weeks and years depending on
the degree and malignancy
occasionally tumours present
acutely due to haemorrhage or the
development of hydrocephalus.
 CLINICAL EFFECTS
1)RAISED INTRACRANIAL PRESSURE
Headache
Papilloedema
2)BRAIN SHIFT
Vomiting
Deterioration of conscious level
Pupillary dilatation
3)EPILEPSY
Generalised
Partial-(simple/complex)
Partial-progressing to generalised
 DISTURBED FUNCTION
A)SUPRATENTORIAL
I.FRONTAL LOBE
1)Contralateral face,arm or leg weakness
2)Expressive dysphasia (Is difficulty in putting words together to make meaning)
3)Personality change--
i)Antisocial behaviour
ii)Loss of inhibitions
iii)Loss of initiative
iv)Intellectual impairments
v)Dementia
 II.TEMPORAL LOBE
1)Receptive dysphasia (difficulty in comprehension)
2)Visual field defects—Upper homonymous quadrantanopia.

III.OCCOPITAL LOBE
1)Visual field defects—Homonymous hemianopia
*Hemianopia-visual loss on the left or right side of the vertical midline
*Homonymous hemianopia-visual field loss on the same sides of both the eyes

IV.CORPUS CALLOSUM
1)Dysconnection syndrome
2)Apraxia(a motor disorder caused by the damage to posterios pareital cortex nd the
individual will have difficulty in planning to perform tasks or movements)
3)Word blindness
 V.PARIETAL LOBE
1)Disturbed sensation
--Localisation of touch
--2 point discrimination
--Passive movement
--Astereognosis or Tactile agnosia
--Sensory inattention
2)Visual field defects
--Lower homonymous quadrantanopia

VI.DOMINANT HEMISPHERE
1)Right/left confusion
2)Finger agnosia
3)Acalculia
4)Agraphia
 VII.NON DOMINANT HEMISPHERE
1)Sensory/Motor neglectDressing apraxia

VIII.HYPOYHALAMUS PITUITARY
1)Endocrine dysfunction
B) INFRATENTORIAL
I.MID BRAIN/BRAIN STEM
1)Cranial nerve lesion (3rd to 12th )
2)Deterioration of conscious level
3)Tremors
4)Impaired eye movements
5)Pupillary abnormalities
6)Vomiting
7)Hiccough
 II.CEREBELLUM

1)Ataxic gait—an unsteady staggering gait,walking is

uncoordinated.
2)Intention tremors
3)Dysmetria—inability to judge distance or scale.
4)Dysarthria—motor speech disorder,causes problems in
muscles that help produce speech,making it very difficult
to pronounce words,characterized by slurred or slow
speech that can be difficult to understand.
5)Nystagmus
 INVESTIGATIONS
I.CHEST X-RAY ,ESR ,CRPThe high
incidence of metastatic tumour make these tests mandatory
in patients with suspected intracranial tumours

II.SKULL X-RAY
1)Calcification
2)Osteolytic lesion
3)Signs of raised intracranial pressure
4)Erosion of posterior clinoids
5)Pineal shift.
III.CT SCANNING
SITE
A)EXTRINSIC—Outwith brain substance
EXAMPLE-Meningioma
B)INTRINSIC—Within the brain parenchyma
EXAMPLE-Astrocytoma
MASS EFFECT
1)Midline shift
2)Ventricular compression
3)Hydrocephalus
 EFFECT ON ADJACENT BONE
-IF meningioma-Hyperostosis(i.e bony hardening or
calcification of ligament in area where they attach to the
spine)
SINGLE OR MULTIPLE LESIONS
-If multiple-metastasis
EFFECT OF CONTRAST
ENHANCEMENT
1)Low grade astrocytoma-none
2)Malignant astrocytoma-irregular
3)meningioma-homogenous
IV.MAGNETIC RESONANCE IMAGING
(MRI)
1)Provide additional information
2)Shows exact anatomical relationship of the tumour to the
sulci and gyri,the ventricles,the falx and the tentorium
cerebelli
3)Intravenous galolinium increases the sensitivity of detection
and clarifies the site of oringin i.e intrinsic or extrinsic.
4)MRI appears more sensitive than CT SCANNING in
identifying small tumours and improves the detection of
multiple lesions
EXAMPLE--Metastasis
 V.ANGIOGRAPHY
1)It may reveal a tumour blush or vessel displacement
2)It is only occasionally required to supplement other
investigations
3)It provides useful pre-operative information in some patients
EXAMPLE—Identifies feeding vessel to a vascular tumour or
tumour involvement & constricyion of major vessels.
VI.CSF EXAMINATION
1)CSF obtained by ventricular drainage or during shunt
insertion then cytological examination may reveal tumour
cells.
 MANAGEMENT
I.MEDICAL MANAGEMENTSteroid therapy is
given that reduces oedema surrounding the intracranial
tumours but do not effect the tumour growth.A loading dose
of dexamethasone 12mg i.v is given.
II.OPERATIVE MANAGEMENT
A)CRANIOTOMYA Flap of bone is cut and reflected.If
necessary combined with image guidance to aid positioning
the flap and to give accurate lesion localisation
B)CRANIECTOMYBurr hole followed by removal of
surrounding bone to extend the exposure
**BURR HOLE-for hand held ultrasound guided biopsy
III.RADIOTHERAPYIt is of particular value in the
management of malignant tumours like
astrocytoma,metastasis,medulloblastoma and germinoma
but also plays an important role in management of some
benign tumours like pituitary
adenoma,carcinopharyngioma.
COMPLICATIONS
1)Increased oedema
2)Demyelination
3)Cognitive impairment
4)Radionecrosis
5)Radiation induced tumours…example-meningioma
IV.CHEMOTHERAPYChemotherapeutic agents
have been used for many years in the management of
malignant brain tumors but their benefits remain limited.
Commonly used drugs include
1)Nitrosoureas
2)Procarbazine
3)Vincristine
4)Methotrexate
COMPLICATIONS
1)Toxicity
2)Drug access
3)Intrinsic resistance
V.PHYSIOTHERAPEUTIC MANAGEMENT
PT treatment for an individual with brain tumour depends upon the
individual’s physical presentation,symptoms and their goals.it
includes-
1)Head neck and trunk control exersices
2)Bed mobility and transfer practice
3)Positioning
4)Upper and lower limb strengthning exersices
5)Sensory stimulation
6)Balancing in sitting and standing
7)Soft tissue mobilization
8)Stretches and massage
9)Gait traininig and stairs practice
10)Home exersice regimen
11)Provision of aids,equipment,positional aids and seating
12)Speech therapy
THANK
YOU