Brain tumors

are group of cells and associated cellular matrix whose growth exceeds and is
uncoordinated with that of normal tissue resulting in disruption of normal tissue
.architecture

:BT

Primary brain tumors arise either from the brain parenchyma or from its -1
intracranial linings

Scondary intracranial tumors that arise in the skull or neighboring structures and -2
extent through the skull or cranial foramina, or they may arise at distant sites and
.spread hematogenously to the brain and dura

Both of them(1˚&2˚) locate either intra-axial: within brain parenchyma or ventricular

:Primary BT
Primary brain tumors are generally classified according to the cell type in which the
abnormal growth occur e.g. astrocytoma for astrocytes however there are some
tumors in which more than one cell type predominate e.g.mixed oligoastrocytoma

:CLASSIFICATION

astrocytic tumors: astrocytoma -1

oligodendroglial tumors: oligodendroglioma -2

mixed:oligoastrocytoma -3

choroid plexus :c.p.papilloma -4

neuronal:gangliocytoma -5

pineal:pinealocytoma -6

embryonal:medulloblastoma -7

meninges:meningiomas -8

germ cell:germinoma -9

sellar region tumor:craniopharyngioma -10

mesenchymal:lipoma -12

In adult the most common primary brain tumors are glioma and meningioma while in
. children medulloblastoma and low grade glioma are the most common brain tumors

:Glioma -1

Tumors arise from neuroglial cell, are the most common primary BT, comprising 50-
.60%, they are diverse in pathology, location, and prognosis

Astrocytoma are the most common glioma consist of 4 main grades 1,2,3,4 of these
grade 4 which called glioblastoma multiformi is the most aggressive astrocytic tumors
.associated with poorer prognosis with high mortality rate

:Ependymoma -2

Are glial neoplasm arising from ependyma and constitute approximately 5% of all
gliomas.approximately two-third of ependymomas occur in the infratentorial
compartment and the most of these present in children, adolescents and young adults.
.The supratentorial ependymomas occur mostly in adult

:Oligodendroglioma -3

Comprise 4% of all glioma, occur in adult patient and it’s unlike the astrocyte group,
.most oligodendrogliomas are well differentiated

Calcium deposits are found in up to 90% of oligodendrogliomas

Meningioma -4

Originate from the arachnoid layer of the meninges, principally the arachnoid villi and
.granulation

Meningiomas are the most common of the benign brain tumours and constitute about
15% of all intracranial tumours, with a mean age of incidence 45 years, females have
meningioma often than male since meningioma exhibit hormonal
factor(progesterone, estrogen) in their genesis ,thus explaining the higher incidence of
.these tumours in women, their accelerated growth during pregnancy
The most common location is in the parasagittal region or in the convexity of the
cranial vault others include sphenoid wing meningioma,olfactory groove, suprasellar
and posterior fossa meningioma

:Clinical features

Many patient develop symptoms months to years before diagnosis with exception of
hemorrhagic tumors.*Patient with SOL presented with signs & symptoms of increase
ICP (intracranial pressure)

1-headache.

2-nuasea & vomiting.

3-blured vision & papilloedema

4-disterb level of consciousness.

5-epilepsy

*Signs & symptoms according to location of pathological lesion the , Like loss of
motor & sensory functions

Frontal lobe=contralateral weakness,motor aphasia(dominant)

Parietal lobe=contralateral sensory loss,sensory aphasia(dominant)

Temporal lobe=epilepsy,memory disterbence

Occipital lobe=visual field defect & cortical blindness

Diagnosis:
Diagnosis started by careful history taking & clinical examination then investigations.

1-skull X-ray may show calcification of tumor(meningioma &oligodendroglioma) or

CT-scan (with or without contrast) CT scan are rapid method of initial screening for -2
a suspected intracranial lesion, they are useful for identifying bony anatomy, tumor
calcification, presence of a mass effect and assessing for acute changes such as
.hemorrhage, edema and hydrocephalus
MRI of brain Give a better and good visualization of a lesion since it’s a method of -3
choice for soft tissue lesion study. Different views can be taken including axial, coronal
.and sagittal allowing details study of a brain lesion

:Angiography .4

Cerebral angiography is useful in study of a vascular tumor study as

:Treatment
medical -1
Aim to reduce high ICP(head elevation, hyperventilation, hypothermia, hyperosmolar
drugs as mannitol, steroid drugs as dexamethasone, barbiturate, and furosemide).
Drugs to control seizure, Medications to treat hormonal disturbance as in pituitary
.tumor

:surgery -2
A biopsy or surgical resection is usually indicated to obtain definitive
.diagnosis

The primary role of surgery is to provide tissue for histopathological

Diagnosis, to alleviate elevated ICP as a result of tumor mass&/or hemorrhage, and to

Tumor biopsy can be carried out by burrhole while tumor removal can be done
.through craniotomy

.Radiotherapy:- Either wholly brain radiation or by gamma knife -3

Indication:
Malignant tumor
Incomplete resected tumor.
Inoperable tumor near vital centers.
Patient unfit for surgery.
chemotherapy --4
Numerous chemotherapy regimes have been reported, including the use of Intravenous
.or intrathecal therapies in chemosensitive tumors

Secondary brain tumor

The route of metastatic spread to the brain is usually hematogenous , although local
;extension can occur the most common primary source of metastasis

lung CA. 2-breast CA. 3-kidney tumor. 4-GIT tumor. 5-melanoma 6-undetermined -1
10%

Intracranial metastasis may be either parenchymal (in the distribution of middle

:Clinical features &diagnosis

:Treatment
medical Steroid medication e.g. dexamethasone will control cerebral edema and -1
.should be commenced immediately if there is raised intracranial pressure

surgery indicated in -2
solitary tumor, surgically accessible & there is no systemic spread -

radiotherapy -3
conventional(whole brain or focal)
& stereotactic radiosurgey(gamma
knife) utilizing highly focused beam
of radiation has been used to treat
single and multiple cerebral
.metastases

chemotherapy used widely in -4