Intracranial tumours

Question 1

Give the 5 possible presentations of intracranial tumours?

Answer 1

1) Raised intracranial pressure
2) Epilepsy
3) Neurological defect
4) Endocrine dysfunction
5) Incidental

Question 2

What are the 3 main symptoms of raised intracranial pressure?

Answer 2

1) Headaches (early morning)
2) Vomiting
3) Blurred vision

Question 3

Give 3 common reasons for a raised intracranial pressure?

Answer 3

1) Tumour mass
2) Surrounding oedema
3) Obstructive hydrocephalus

Question 4

Intracranial tumours can present with seizures (epilepsy) what are the 4 types of seizures?

Answer 4

1) Partial
2) Complex partial
3) Secondary
4) Generalized

Question 5

What kind of tumours tend to present with seizures?

Answer 5

Supratentorial tumours - brain stem tumours or cerebellar tumours unlikely to cause seizures

Question 6

What are the 5 common types of neurological deficit that intra cranial tumours can present with?

Answer 6

1) Cognitive
2) Visual
3) Cranial nerve
4) Motor
5) Sensory
Different deficits depending on where the tumour is located

Question 7

Schwanoma tends to occur on which cranial nerve?

Answer 7

Vestibulocochlear

Question 8

Which kind of intracranial tumour is most likely to lead to endocrine problems?

Answer 8

Pituitary gland tumour

Question 9

What 2 kinds of tumours are commonly found incidentally when performing cranial imaging for other reasons?

Answer 9

1) Meningiomas

2) Pituitary tumours

Question 10

On examination of a patient with a possible intracranial tumour which 4 aspects should be examined?

Answer 10

1) Higher mental function
2) Cranial nerve abnormality
3) Motor/sensory abnormalities
4) Cerebellar signs

Question 11

What 3 tumour markers can be raised indicating a tumour?

Answer 11

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

Question 12

What 5 investigations could be performed on a patient with suspected intracranial tumour?

Answer 12

1) Haemotological
2) Tumour markers
3) Hormonal assay
4) Visual fields
5) CXR - could be lung mets (common cause of brain tumour)

Question 13

Aswell as a CT and MRI head, what other imaging can be used to investigate suspected intracranial tumours?

Answer 13

Cerebral angiography

Question 14

What is a functional MRI (fMRI)?

Answer 14

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

Question 15

What does DTI (diffusion tensor imaging) allow you to visualise in the brain? How is this useful in brain tumour investigation?

Answer 15

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

Question 16

What is the function of MR spectroscopy?

Answer 16

Allows you to analyse levels of metabollites within intracranial tumours and this differentiate between tumour types

Question 17

What are the 3 most common types of drugs used in the management of intracranial tumours?

Answer 17

1) Steroids
2) Anti-convulsants
3) Hormonal replacement

Question 18

Give 3 reasons for performing surgery in the management of intracranial tumours?

Answer 18

1) Diagnostic
2) Remove mass effect and alleviate symptoms
3) Treat complications (eg. hydrocephalus)

Question 19

What are the 4 technical surgical options for obtaining a biopsy in intracranial tumours?

Answer 19

1) Stereotactic
2) Neuro-navigation
3) Endoscopic
4) Free hand

Question 20

How is a stereotactic biopsy obtained?

Answer 20

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

Question 21

How is neuronavigation used to obtain a biopsy? What is the level of accuracy?

Answer 21

Feed in the brain scan data - probes will then lead you straight to the tumour
Has a

Question 22

Once a biopsy has been obtained what is the purpose of a frozen section?

Answer 22

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

Question 23

Why is 5-ALA given prior to resection surgery for brain tumour?

Answer 23

Given intravenously prior to surgery
Tumour cells then accumulate 5-ALA
This improves tumour resection as tumour cells can be seen more easily

Question 24

What is the advantage of the use of carmustine wafers (Gliadel) in treatment of intracranial tumours, how are they put in place?

Answer 24

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

Question 25

How can intra-operative MRI be useful in surgery?

Answer 25

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

Question 26

Once surgery has been performed what are the 3 further management aspects?

Answer 26

1) Possible further surgery
2) Radiological surveillance
3) Adjuvant therapy - chemo/radio therapy

Question 27

What are the 2 surgical options for treating hydrocephalus, a possible complication of an intracranial tumour?

Answer 27

1) Third ventriculostomy

2) Ventriculo-peritoneal shunt

Question 28

What are the 3 hopeful future treatment options for intracranial tumours?

Answer 28

1) Radiosurgery
2) Gene therapy
3) Chemotherapy