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Neurosurgery > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

Symptoms of a Brain Tumour

A 
Non-Localising: 
1- Apathy 
2- Personality change 
3- Dementia 
4- Drowsiness

Localising
1- Cranial Nerve palsy
2- Seizures : generalized/focal ( usually initial presentation )
- have to differentiate between is seizure to TIA/vasovagal
3- Lobar : ex: if frontal then changes in sensation , temporal for memory/concentration
4- differentiate between new onset neurological symptoms form stress

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2
Q

2/3 of patients with space occupying lesions have which classical symptoms

A

Due to Raised ICP
1- Headache
2- Papilloedema
3- Vomiting

Maybe mental disturbance : drowsiness, coma , dementia , mild personality change

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3
Q

Presentation of Raised ICP headache due to space occupying lesion

A
  • Headache presented on waking up.
    Time: disperses within 1-2 hours , can disappear for days or weeks

Characteristics: not of great intensity, throbbing or bursted - usually dull ache

Exacerbating : aggravated by coughing , sneezing , stooping down or exertion

Relieving: relieved by aspirin , codeine , rest

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4
Q

Occipital headache radiating down the neck can indicate what

A

Post fossa / CP angle tumour

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5
Q

Explain Vomiting presentation in space occupying lesions with raised ICP and where is vomiting most common

A

Vomiting :

  • projectile with no nausea or warning
  • before breakfast , with headache

Common in

  • children more than adults
  • post fossa tumours than supratentorial tumours
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6
Q

Explain the Papilloedema presentation in space occupying lesions with raised ICP

A
  • Usually asymptomatic
  • vision could be affected
  • enlargement of blind spot and late peripheral constriction of fields
  • Usually intermittent loss of vision rather than steady deterioration : amaurosis
  • Attacks could be triggered by getting up from sitting/lying down : in the morning
  • sleeping may trigger episodes of vision loss
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7
Q

What is Amaurosis and how does it present with space occupying lesions

A

Vision loss without apparent lesion affecting eye.

Presentation : Fugal bilaterally and lasting less than 1 minute

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8
Q

What are the 2 main types of Intracranial tumours

A

1- Primary : arise within the brain , categorized via where they arise from
2- Secondary : metastases from cancer elsewhere in body. Usually lung and breast

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9
Q

What is the most common cancers to metastases to the brain

A

Lung and breast cancer

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10
Q

What percentage of brain tumours are Primary , and what percent of malignant Brian tumours are Primary

A

30% of all Brian tumours

80% of malignant brain tumours

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11
Q

Where do Primary Brain tumours originate from and what Is each type of tumour called

A

3 main glial cell types
1- Astrocytomas : astrocytes
2- Oligodendrogliomas : oligodendrocytes
3- Ependymomas : ependymal cells

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12
Q

What are Diffusely Infiltrating Astrocytomas , Explain different Grades and if surgical excision is possible

A

Tumours developing from a mass but also diffusely infiltrate normal brain = Precludes complete surgical excision

Grade 2 : slow growing , eventually will progress to malignant. 5-7 years survival
( common in younger people , present with seizures )

Grade 3 : Anaplastic Astrocytoma , higher proliferation rate, mitotically active. 2-3 years survival

Grade 4: Glioblastoma, elevated tumour cell proliferation, endothelial proliferation, vascular supply and necrosis. 12-18 months survival

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13
Q

Explain the treatment of Gliomas ( surgical )

A

1- Histological tissue is obtained for diagnosis via closed biopsy or open craniotomy
2- Tumour debulking of focal tumours to relieve mass or pressure effect if it is safe to do so

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14
Q

Most brain tumours are Primary or Secondary

A

Secondary

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15
Q

Most common type of Primary tumours is which ?

A

Gliomas ( glial cells )

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16
Q

List categories of Primary tumours

A

1- Gliomas : glial cells
2- Meningiomas : arachnoid cap cells
3- Pituitary adenoma : pituitary cells
4- Schwannomas : arise form intracranial nerves

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17
Q

Imaging modalities to diagnose brain tumours

A

1- MRI + contrast: shows area of disease in brain ( infiltration )
2-
3-

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18
Q

Imaging modalities to diagnose brain tumours

A

1- MRI + contrast: shows area of disease in brain ( infiltration ) and leaky vessels in tumour
2- PET scan : sensitive guide to indicate malignancy

19
Q

Surgery for Brain tumours Complication and risks

A

1- Post -operative complication may render patient disabled or unfit for subsequent oncological treatment
2- Risk of death <15 , risk of haemorrhage <5% , infection 5 , seizures

20
Q

Limitations of brain tumours surgery ( 3 )

A

1- If cortical and subcortical low density presenting with seizures and progressive headache = surgical treatment limited to diagnostic biopsy

2- Low grade thalamic astrocytoma presenting with progressive hemiparesis = surgical treatment limited

3- deep tumour = high risk of defect post operatively

21
Q

Surgical techniques used to facilitate maximal safe resection of brain tumours

A

1- Image guidance ( pre-op scans )
2- Real time intra-operative imagine ex: Ultrasound , CT, MRI
3- Tumour fluorescence, patient drinks to helps to visualize malignant gliomas
4- Awake surgery with direct electrical stimulation and speech/physiotherapist monitoring

22
Q

Post surgical adjacent therapy for malignant gliomas

A

1- Course of fractionated radiotherapy over 2-6 weeks
2- Temozolomide for Glioblastomas that cause DNA damage in tumour cells
3- Radiotherapy + PCV ( Procarbazine, lomustine, vincristine ) chemotherapy for anapaestic oligodenregliomas

23
Q

Which type of Astrocytoma doesn’t infiltrate the brain

A

Type 1 pilocytic astrocytoma

24
Q

Do Astrocytomas or Oligodenrogliomas have a better life expectancy

A

Oligodenrogliomas

25
Q

What are Meningiomas, different grades & their treatment

A 
Arise from arachnoid cap cells of meninges 
Grade 1 ( bening ) , Grade 2 ( atypical ) , Grade 3  ( malignant ).

Majority are benign and resected if possible. Small risk of local recurrence but there’s still follow up imaging.

If tumour indeed-seated locations or adherent to important blood vessels or nerved there will be SRS or other forms of radiotherapy

Grade 2 have higher propensity to recur locally
Grade 3 are malignant and likely to recur in shorter period and have a risk of extra-cranial metastasis

26
Q

Primary sites of Brain metastases

A 
1- Lung 
2- Breast 
3- melanoma 
4- Renal 
5- Thyroid
27
Q

Treatment options for brain metastases are dependent on ?

A

Patient performance status , tumour burden and primary cancer type , age , number and volume of brain mets , expected prognosis

28
Q

Surgical resection of brain metastases are usually for which kind of tumours

A

Large tumours causing pressure effects

29
Q

What is SRS

A

Stereotactic Radiosurgery that focuses beams of radiation to small or medium sized tumours

30
Q

What is used for widespread brain metastases palliative care

A

Whole brain radiotherapy

31
Q

If BBB is permeable and patient has Brain metastases what treatment option is used

A

chemotherapy / systemic anti-cancer treatement

32
Q

What is a Spinal ependyomoma and what is done during surgery

A

Spinal tumour and during surgery there is monitoring of signals to legs to limit any spinal cord trauma.

33
Q

What are the 3 types of radiation techniques for Brian tumours

A

1- Conventional fractionated radiotherapy ( whole brain )
2- advanced ERBT techniques ( IMRT )
3- Sterotactic radio surgery/therapy

34
Q

Explain childhood brain tumours

A

Location: usually in infratentorial compartment ( cerebellum , fourth ventricle )

Surgery : complete surgical resection is optimal primary treatment

Types :
1- Pilocytic astrocytoma : complete resection can lead to normal life expectancy
2- Medulloblastoma: can metastasize through CSF pathways ( spine ). Require post surgical radio&chemotherapy
3- Ependymoma : tendency to recur and metastasize. Anaplastic ependymoma requires post-operative radio

35
Q

Wen is radiotherapy avoided and why

A

In ages under 4 due to CNS toxicity on developing Brian and spinal cord

36
Q

What is proton therapy

A

A form of targeted radiation used for Brain tumours. Only affects tumour cells

37
Q

Explain Cranial Nerve tumour ; vestibular schwannomas ( presentation and association conditions )

A

Location : Slow growing benign nerve sheath tumours arising on vestibular nerve

Presentation: Hearing loss, Tinnitus , balance problems

Associated with Neurofibromatosis

38
Q

What treatment is indicated for small volume lesions <3cm in diameter and Bria metastases

A

Stereotactic Radiosurgery

39
Q

Explain Presentation of Pituitary tumours

A

Large ( marcroadenomas )

  • Compression of adjacent structures
  • compression of optic nerves = bitemporal hemianopia

Small( micro adenomas )

  • prolactinoma
  • GH-secreting ( acromegaly)
  • ACTH ( Cushing’s disease )
40
Q

General Principles of Brain Tumours

A
  • Early detection = better prognosis
  • symptoms referable to tumour site
  • Surgery Biopsy for diagnosis / resection to alleviate mass
  • Post-operative Radiotherapy for malignant tumours
  • Post-operative chemotherapy , usually for malignant gliomas
    SRS for brain metastases & brain tumours of small volume
41
Q

What is the Palliative Care for Brain tumours

A

1- Medication to manage symptoms
2- Anti-seizure medication in tumour delayed epilepsy
3- Anti-emetics , analgesics
4- Dexamethasone for peri-tumoral oedema
5- end of life car/hospice

42
Q

How do brain tumours develop

A

1- Deregulated cell division and loss of normal checkpoint controls
2- Angiogenesis : recruitment of blood supply to feed tumour
3- invasion/infiltration into surrounding brain
4- Metastases
5- Tumours can adapt

43
Q

What is Angiogenesis

A

recruitment of blood supply to feed tumour

Neurosurgery (4 decks)

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