Brain Tumors and Gamma Knife

Question 1

neoplasia that affects the CNS specifically the brain and can be sub-categorized as primary or secondary

Answer 1

brain tumors

Question 2

tumors that begin in CNS

Answer 2

primary tumors

Question 3

examples of primary tumors

Answer 3

astrocytomas and gliobastomas
meningiomas, neuronimoas, pituitary adenomas

Question 4

tumor begins in other tissue outside CNS

Answer 4

secondary tumors

Question 5

a noninvasive form of radiation therapy to treat cancerous/non-cancerous tumors with high power energy focused on a small area of the body

Answer 5

gamma knife

Question 6

s/s brain tumors

Answer 6

• depends on location and size of tumor
  HA
  visual changes
  N/V
  cognitive changes
  lethargy
  behavioral changes
  seizures
  syncope
  weakness
  hemiplegia/paresis
  apraxia
  cortical sensory deficits

Question 7

dx brain tumors

Answer 7

MRI and CT
blood tests (for hormones and markers)
neuro exam
PET scan
biopsy

Question 8

pathogenesis brain tumors

Answer 8

• affect brain through compression of cerebral tissue, CN, invasion and infiltration of cerebral tissue and sometimes erosion of bone
• cause cerebral edema and increased ICP

Question 9

what is the most common primary brain tumor

Answer 9

gliomas (30-40%)

Question 10

describe what population low-grade astrocytomas impacts

Answer 10

10-12% all primary tumors in adults
most common intracranial tumor in kids

Question 11

describe what population high grade malignant astrocytomas impact

Answer 11

more common in adults
20-35% primary brain tumors

Question 12

describe what population oligodendrogliomas impact

Answer 12

10-15% gliomas
most frequently in middle aged adults
can also be found in children

Question 13

what is the second most common primary intracranial brain tumor in adults

Answer 13

meningiomas

Question 14

age group of meningiomas affected

Answer 14

40-70 y/o
2x more prevalent in women

Question 15

what are the 3rd most common primary brain tumors

Answer 15

pituitary adenomas

Question 16

what population are pituitary ademonas most prevalent

Answer 16

women > M
during childbearing year

Question 17

diff dx brain tumors

Answer 17

tremors
stroke
subdural hematoma
meningitis
orbital optic neuritis
AVM
brain abscess
neurosyphilis

Question 18

red flags brain tumors

Answer 18

changes in personality/behavior
weakness
numbness
loss of function one side of body
sudden difficulty with balance
dizziness
sensory changes (hearing, seeing, smell)

Question 19

dietz classification scale for PT POC

Answer 19

preventative
restorative
supportive
palliative

Question 20

PT POC

Answer 20

regain mobility, balance, strength
- neck/head control, sitting balance or standing, gait

Question 21

5 and 10 year survival rates brain tumors

Answer 21

5 - 36%
10 - 31%

Question 22

medications of brain tumors

Answer 22

• temozolomide - most common
• carmustine, irinotecan, lomustine, procarbazine
• anti-inflammatory and antiepileptic for swelling and seizures

Question 23

describe gamma knife

Answer 23

• highly accurate beams of high dose radiation
• does not remove the tumor but delivers precise radiation that destroys tumor cells and spares surrounding tissues
• halo device attached to skull and pt head in a collimator that delivers focused gamma beams to targeted tumor
• 20 minutes - 2 hour tx sessions
• pt awake and typically about 5 sessions

Question 24

expected outcomes brain tumors

Answer 24

• depends on severity
• goal is to regain function (strength, endurance, balance)
• communication important