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5.1 UTM > Neurooncologi BS > Flashcards

Neurooncologi BS Flashcards

1
Q

Primary brain tumors
Intraaxial/intrinsic/parenchymal
VS
Extraaxial/extrinsic
explain

A

Intra:
-Always malignant except hemangioblastoma
-Infiltrative
-All type of glioma, most in adult: Glioblastoma multiforme

Extra:
-Benign, capsulated
-Compresses surrounding brain
-Meningioma, neurinoma

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1
Q

Klasifikasi tumor otak (5)

A

-Neuroepithelial
-Meningioma
-Acoustic neuroma
-Pituitary adenoma
-Metastatic tumor

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2
Q

Tumor otak persentase tertinggi

A

Neuroepitelial

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3
Q

Tumor neuroepitelial persentase tertinggi

A

Glioma/astrocytoma

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4
Q

Most brain tumor location (which lobe)

A

Frontal lobe

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5
Q

Malignant tumors more likely in … (men/women), meanwhile non malignant tumors more likely in …

A

men , women

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6
Q

Clinical manifestations of brain tumor (2)

A

-Increased ICP
-Focal sign and symptoms

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7
Q

Glioma/astrocytoma explain:
intrinsic/extrinsic?
border?
low-high grade benign or malignant?
continuum with what tumor?
low grade characteristis?
anaplastic astrocytoma characteristics?
Glioblastoma multiforme characteristics?
May invade whole hemisphere, and it is called?

A

Intrinsic
no clear border
low-> benign, high-> malignant
Glioblastoma multiforme
Avascular, fibrous
Nuclear pleomorphism, mitosis
Endothelial prolif, central necrosis
Gliomatosis cerebri

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8
Q

Glioma/astrocytoma grading

A

Pilocytic astrocytoma (grade I)
1: Astrocytoma (grade II)
2: Anaplastic astrocytoma (Grade III)
3-4: Glioblastoma multiforme (Grade IV)

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9
Q

Astrocytoma histologic diagnosis parameters (4)

A

Nuclear atypia
Mitoses
Endothelial proliferation
Necrosis

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10
Q

Anaplastic astrocytoma:
Prone to?
Morphology?

A

Prone to hemorrhage
Grossly, friable, granular, gray

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11
Q

Glioblastoma Multiforme, key features

A

endothelial proliferation and necrosis

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12
Q

Gliomas, aims of surgery (3)

A

provides pathological dx
decrease ICP
cytoreductive

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13
Q

Gliomas, type of surgery

A

-lobectomy (cerebral poles)
-resection/biopsy (involves eloquent area)
-stereotactic biopsy (small, deep tumor)

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14
Q

High grade glioma management

A

high grade: 100gr with 10^11 cells

Radical excision -> RDT -> Chemotx

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15
Q

Glioma nomenclature

A

diagnosis final: histo - grade - molecular characteristics

Anaplastic astrocytoma - WHO Grade III - IDH-wild type

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16
Q

glioma prognosis parameter (3)

A

-isocitrate dehydrogenase mutation
-O-6-methylguanine-DNA methyltransferase promoter methylation
-1p19q co-deletion

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17
Q

Meningioma peak incidence age

A

45, decade 4-6

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18
Q

Meningioma f:m ratio and spinal meningioma f:m ratio

A

3:2
spinal-> 5:1

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19
Q

Meningioma mostly located … , where specifically ..

A

supratentorial, falk-parasagittal (25%)

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20
Q

Meningioma classification based on

A

site of attachment and location

21
Q

Meningioma grading WHO 2000

A

Grade I -> benign
Grade II -> atypical
Grade III -> malignant/anaplastic

22
Q

Simpson classification of extent of resection

A

I. Gross total resection of tumor, dural attachment, abnormal bone
II. Gross total resection of tumor, coagulation of dural attachments
III. Gross total resection of tumor, w/o resection/coagulation of dural attachments or extradural extension
IV. Partial
V. Biopsy (simple decompression)

23
Q

Meningioma angiography purpose: (3)

A

-see tumor blood supply
-see intra tumoral vascular network
-see shift/encasement of intracranial large vessel

24
Q

meningioma blood supply
Falcine/convexity tumor?
Frontobasal tumor?
Ventricular tumor?

A

MMA
Ethmoidal artery
Choroidal artery

25
Q

Management of meningioma, best choice

A

total removal tumor, dural attachment, involved bone

base of brain, dural removal is not possible

26
Q

Meningioma goals of surgery (3)

A

-total removal tumor, dural, bone
-relieving neurological symptoms
-avoid CSF leakage after surgery

27
Q

Preop management?
and in perifocal edema?

A

Perifocal edema-> IV steroid 5-7 days prior to surgery, tapered postop

mannitol->during craniotomy before opening duramater

CSF drainage

Hb concentration brought up to >= 13g/dL

Antibiotic, broad spectrum iv, 1 hour preop

28
Q

in medial sphenoid wing meningioma/clinoidal meningioma, encasement of ICA, MCA has risk of

A

Postop arterial spasm causing infarction

29
Q

If there is mass effect and high ICP, emergency basis?

A

decompressive craniotomy

30
Q

Meningioma surgical complication

A

Hematoma at tumor bed
Pneumocephalus
Infarction

31
Q

Schwannoma f:m ratio

A

2:1

32
Q

Schwannoma morphology?

A

grossly firm, circumscribed, encapsulated

33
Q

Schwannoma classification (microscopically) (2)

A

Antoni type A and B

34
Q

Curative therapy Schwannoma

A

Total resection

34
Q

Schwannoma size
small?
medium?
large?

A

<1,5cm
1,5-2,5cm
>2,5cm

35
Q

Acoustic Neuroma caused by loss of function of a gene on chromosome … which has a function of … ?

A

22, supresses growth of Schwann cells (neurofibromatosis type 2)

36
Q

Acoustic neuroma clinical mainfestation (early 4, late +1)

A

-Hearing loss unilateral
-Tinnitus
-Loss of balance
-Fullness in ear

-ICP increase (hydrocephalus)

37
Q

Acoustic neuroma treatment (3)

A

Observation:
-<2cm
-old
-minimal symptom

Radiation
-small/medium
-old
-not pressing on brainstem

Microsurgery
-large >2.5cm
-small/possible hearing
-young,healthy

38
Q

Preservation of CN function during operation is called … consists of (3)

A

Intraoperative Monitoring (IOM)
-Direct stimulation of facial nerve (NIM Response)
-Transcranial electrical stimulation of facial motor cortex
-Auditory brainstem response (ABR) via Electrocochleagram (ECoG)

39
Q

Pituitary adenoma arise from which lobe … which develops from …

A

Anterior lobe (adenohypophysis) , Rathke’s pouch

40
Q

Pituitary adenoma benign lesion mostly found in … and mostly accompanied by … syndromens of compression of …

A

Sella turcica; hypersecretory syndrome; compression of optic nerve, optic chiasm, cavernous sinus, occulomotor nerve, etc

41
Q

Pituitary adenoma aim of therapy

A

Hormonal balance and preservation of neurological function

42
Q

Pituitary adenoma classification based on size

A

Microadenoma <10mm
Macroadenoma >10mm

42
Q

macroadenoma pituitary hydrocephalus patophysiology

A

macroadenoma -> grow locally -> erosion and remodelling of sellar floor and posterior clinoid process -> spread superiorly compressing optic chiasm -> may obstruct 3rd ventricel

43
Q

Classification of pituitary adenoma which has no hormone (2)

A

Null Cell, acidophil stem cell

44
Q

Classification of pituitary adenoma largest percentage

A

Prolactin

45
Q

Pituitary adenoma Clinical manifestation (mass effect)

A

-headache (acromegaly)
-Chiasmal syndrome (visual acuity, field)
-Hypothalamic syndrome (thirst, sleep, appetite, temperature regulation, Diabetes Insipidus)
-3rd ventricle obstruction (hydrocephalus)

46
Q

Pituitary adenoma Clinical manifestation (endocrine disturbance)

A

PRL: amenorrhea-galactorrhea
GH: gigantism-acromegaly
ACTH: cushing disease
TSH: thyrotoxicosis
Acute panhypopituitarism -> usually after tumor apoplexy

47
Q

Operative approach for pituitary (5)

A
  1. Transcranial/craniotomy
  2. Sublabial transseptal transsphenoidal
  3. Endonasal transsphenoidal (this)
  4. Transsphenoidal with endoscopic assisted
  5. Fully endoscopic transsphenoidal surgery
48
Q

Endonasal transsphenoidal approach (step by step)

A
  1. Vertical incision of septal mucosa of rt.nostril, at bone-cartilage junction
  2. Bilateral mucosal dissecion posteriorly, starts from the anterior edge of the bony septum
  3. Visualization of rostrum sphenoid sinus
  4. Removal of the bony nasal septum
  5. Removal of anterior wall of the sinus
  6. Coagulation of the mucosa of the sinus and removal of the sellar floor
  7. Coagulation & incision of the sellar dura
  8. Removal of the Macroadenoma

5.1 UTM (13 decks)

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