Intracranial tumours Flashcards
Give the 5 possible presentations of intracranial tumours?
1) Raised intracranial pressure
2) Epilepsy
3) Neurological defect
4) Endocrine dysfunction
5) Incidental
What are the 3 main symptoms of raised intracranial pressure?
1) Headaches (early morning)
2) Vomiting
3) Blurred vision
Give 3 common reasons for a raised intracranial pressure?
1) Tumour mass
2) Surrounding oedema
3) Obstructive hydrocephalus
Intracranial tumours can present with seizures (epilepsy) what are the 4 types of seizures?
1) Partial
2) Complex partial
3) Secondary
4) Generalized
What kind of tumours tend to present with seizures?
Supratentorial tumours - brain stem tumours or cerebellar tumours unlikely to cause seizures
What are the 5 common types of neurological deficit that intra cranial tumours can present with?
1) Cognitive
2) Visual
3) Cranial nerve
4) Motor
5) Sensory
Different deficits depending on where the tumour is located
Schwanoma tends to occur on which cranial nerve?
Vestibulocochlear
Which kind of intracranial tumour is most likely to lead to endocrine problems?
Pituitary gland tumour
What 2 kinds of tumours are commonly found incidentally when performing cranial imaging for other reasons?
1) Meningiomas
2) Pituitary tumours
On examination of a patient with a possible intracranial tumour which 4 aspects should be examined?
1) Higher mental function
2) Cranial nerve abnormality
3) Motor/sensory abnormalities
4) Cerebellar signs
What 3 tumour markers can be raised indicating a tumour?
1) aFP
2) Bhcg
3) PSA
Even if not markers of brain tumour could be brain mets and have raised markers of the primary cancer
What 5 investigations could be performed on a patient with suspected intracranial tumour?
1) Haemotological
2) Tumour markers
3) Hormonal assay
4) Visual fields
5) CXR - could be lung mets (common cause of brain tumour)
Aswell as a CT and MRI head, what other imaging can be used to investigate suspected intracranial tumours?
Cerebral angiography
What is a functional MRI (fMRI)?
MRI performed whilst patient asked to perform certain functions - eg. speech is lateralised to the left hemisphere - left hemisphere shown as activated when patient asked to speak
What does DTI (diffusion tensor imaging) allow you to visualise in the brain? How is this useful in brain tumour investigation?
White matter - eg. allows you to see if corticospinal tracts have been moved - mass effect, and also decide a route of access to the tumour in surgery
Therefore useful in counselling and planning
What is the function of MR spectroscopy?
Allows you to analyse levels of metabollites within intracranial tumours and this differentiate between tumour types
What are the 3 most common types of drugs used in the management of intracranial tumours?
1) Steroids
2) Anti-convulsants
3) Hormonal replacement
Give 3 reasons for performing surgery in the management of intracranial tumours?
1) Diagnostic
2) Remove mass effect and alleviate symptoms
3) Treat complications (eg. hydrocephalus)
What are the 4 technical surgical options for obtaining a biopsy in intracranial tumours?
1) Stereotactic
2) Neuro-navigation
3) Endoscopic
4) Free hand
How is a stereotactic biopsy obtained?
Frame is put on the brain and every point in space allocated an X,Y and Z value. The target is identified and the needle will go exactly to that point
How is neuronavigation used to obtain a biopsy? What is the level of accuracy?
Feed in the brain scan data - probes will then lead you straight to the tumour
Has a
Once a biopsy has been obtained what is the purpose of a frozen section?
To confirm abnormal tissue - for some intrinsic tumours, normal/abnormal tissue is difficult to establish operatively, for example oedema surrounding the tumour can look abnormal
Once abnormal tissue is confirmed then subsequent tumour resection can proceed
Why is 5-ALA given prior to resection surgery for brain tumour?
Given intravenously prior to surgery
Tumour cells then accumulate 5-ALA
This improves tumour resection as tumour cells can be seen more easily
What is the advantage of the use of carmustine wafers (Gliadel) in treatment of intracranial tumours, how are they put in place?
Put in place during surgery - remove the tumour then line with wafers
Advantage is this allows the chemotherapy agent to bypass the BBB which can be a potential obstacle for some agents
How can intra-operative MRI be useful in surgery?
For example in cases where the entire tumour needs to be resected - ependymomas - can perform MRI to check if everything has been resected and continue if any has been missed
Once surgery has been performed what are the 3 further management aspects?
1) Possible further surgery
2) Radiological surveillance
3) Adjuvant therapy - chemo/radio therapy
What are the 2 surgical options for treating hydrocephalus, a possible complication of an intracranial tumour?
1) Third ventriculostomy
2) Ventriculo-peritoneal shunt
What are the 3 hopeful future treatment options for intracranial tumours?
1) Radiosurgery
2) Gene therapy
3) Chemotherapy
