12.4 Brain Tumors

Question 1

Types of Primary Tumors

Answer 1

• Gliomas
• Meningiomas
• Acoustic Neuromas
• Pituitary Adenomas

Other Tumors
- Angiomas - Masses of abnormal blood vessels and metastatic tumors

Question 2

Intra-Axial Tumors

Answer 2

• Located in cerebrum, cerebellum and brainstem

Types
- Astrocytoma
- Oligodendroma
- Ependymoma

Question 3

Extra-Axial Tumors

Answer 3

• Originate outside the brain

Most common
- Meningiomas
- Schwannomas
- Pituitary Tumors

Question 4

Astrocytoma

Answer 4

• Rarely spread outside brain and CSF
• Treatment aimed at prolonging life
• Includes surgical resection, radiation therapy, stereotactic radiosurgery, and chemotherapy

Question 5

Oligodendroma

Answer 5

• Similar to Astrocytoma
• Can spread to CSF but rarely spreads outside brain or spinal cord
• Treatment is surgical resection and radiation therapy

Question 6

Endendymomas

Answer 6

• Originate in ependymal cells lining ventricles
• Found in brain/spinal cord
• Can spread through CSF but NOT BRAIN TISSUE
• Can obstruct CSF and cause hydrocephalus
• Treatment is surgical resection
• Shunt may be put in place and radiation therapy

Question 7

Meningiomas

Answer 7

• Most common brain tumor that arise from meninges.
• Slow growing, firm, encapsulated.
• Surgical resection is treatment

Question 8

Schwannomas

Answer 8

• Usually BENIGN
• Most often occur on cranial nerve 8 (acoustic neuromas)
• Can also compress facial and trigeminal nerves (5 and 7)

Treatment
- Gamma knife surgery for symptomatic lesions
- Open surgery for lesions greater than 3 cm
- Complete resection may be possible

Question 9

Pituitary Adenomas

Answer 9

• Occurs in anterior lobe
• Classified based on the type of hormone affected
• Also classified as functioning, hormone-secreting or nonfunctioning

Question 10

Metastatic Tumors

Answer 10

• Originate in another body part and travel to the brain
• Most commonly from lungs, breast and skin cancer
• Spread via arteries and meninges
• Head and neck melanoma can go directly to the brain

Question 11

Brain Tumors

Answer 11

Manifestations
- Localized/generalized neurologic symptoms
- Increased ICP
- Headache/Vomiting/Visual Disturbances/Seizures
- Hormonal effects with pituitary adenoma
- Loss of hearing, tinnitus, vertigo, with acoustic neuroma

Question 12

Diagnostics for Brain Tumors

Answer 12

• Neurological Exam
• CT/MRI/PET/EEG
• Cytotoxic study of CSF
• Biopsy

Question 13

Medical Management

Answer 13

Surgery
- Goal to remove tumor without neurological symptoms or to relieve compression symptoms

Radiation Therapy
- Cornerstone of treatment for brain tumors

Chemotherapy
Pharmacological Therapy

Question 14

Surgical Excision

Answer 14

• Used to establish pathology, diagnosis and treatment plan
• Debulk the tumor

Post-Op Care
- Initial monitoring in ICU
- ICP monitoring

Question 15

Radiation Therapy

Answer 15

• Used to slow tumor growth, stabilize tumor, prevent recurrence, and increase quality of life/survival.

External Beam Radiation
- Focused directly on tumor
- Whole-brain radiation is only used for multiple metastatic lesions

Brachytherapy
- Internal radiation implanted directly into the tumor bed.
- Used for high-grade gliomas

Stereotactic Radiation
- NOT SURGERY
- Delivers single high dose of radiation
Includes
- Gamma Knife Radiosurgery
- Cyber Knife Radiosurgery