CNS Tumors - Merkin

Question 1

What are the 3 most comon primary brain tumors in adults and how are they differentiated?

Answer 1

1. Astrocytomas (Gliomas-50%)
2. Meningiomas (20%)
   - Highly vascularized
   - Exraaxial
   - Better prognosis
3. Others (30%)
   - Hemangiocytoma

Question 2

What are the differential diagnoses for ring enhanced lesion in brain CT?

How is a diagnosis made?

Answer 2

Glioma (high grade)/glioblastoma multiforme (GBM)

Metastatic tumor (CNS lymphoma)

Brain abscess

Toxoplasmosis (HIV)

-Stereotactic therapy after steroids

Question 3

What is the prognosis of astrocytoma/glioblastoma multiforme?

What is the treatment?

Answer 3

With treatment:

Grade Survival
I 8-10 years
II 7-8 years
III 2 years
IV <2 years

Surgery, radiation and chemotherapy (Temodal is gold standard)

Question 4

What is the Karnofsky Performance Status (KPS)?

Answer 4

Assesses function on a scale of 1-100 <70 is unable to care for self (bad prognosis)-surgery is no longer indicated

Question 5

What are possible treatments for brain tumors that are small or in a location difficult to resect?

Answer 5

Gamma knife:
As effective as surgery, a helmet with 200 rays that center at the tumor.
Very expensive, none in Israel

Linear acceleration:
Several rays that move in a complicated trajectory concentrated at one point. Removes SOL, decreases ICP and increases function.