Neurosurgical Conditions

Question 1

The commonest CNS tumor is:

A. Astrocytoma
B. Craniopharyngoma
C. Meningioma
D. Primitive neuroectodermal tumor (PNET)
E. Ependymoma

Answer 1

A

Astrocytoma is the commonest CNS tumour, accounting for 32 percent, craniopharyngioma 5.8 per cent, 
meningioma 2.8 percent, 
mixed meningioma 3.6 percent, 
pinocytoma 0.5 percent, 
PNET 17.6 percent, 
ependimoma 5.7 percent, 
rhabdoid 12 percent, 
oligodandrioglioma1.9 percent, 
gangliolioma 7.9 percent, 
germ cell tumour 7.9 percent, 
choroid plexus 2.6 percent, 
pituitary adenoma 1.1 percent, 
metastatic tumour 1.0 percent.

Syed/MCQ

Question 2

The commonest site of distribution of brain tumor is:

A. Supratentorial hemispheric
B. Infratentorial
C. Supratentorial
D. Suprasellar
E. Pineal region

Answer 2

B
Infratentorial is commonest (45–60 percent).
Supratentorial hemispheric is 25–40 percent.
Supratentorial midline is 15–20 percent.
Supraseller and pineal region tumour fall into the category of supratentorial midline tumours.

Syed/MCQ

Question 3

Regarding diagnostic study of CNS tumor, all of the following are correct except:

A. CT scan is better than MRI.

B. Intramural calcification in teratoma is seen poorly on MRI.

C. CSF can show high AFP and B-HCG in germ cell tumor.

D. Embolization is required preoperatively.

E. Post-operative imaging is required to assess the extent of tumor resection and complication like hematoma and hydrocephalus.

Answer 3

A

MRI is better than CT. MRI provides multiplane images that are helpful in planning surgery and with new imaging sequence and spectroscopy, may even provide specific diagnosis.

Intramural calcification, which is seen in craniopharyngioma and teratoma, is poorly seen with MRI.

Optimal characterisation of tumour may require both CT and MRI.

Syed/MCQ

Question 4

Regarding central nervous tumour all of the following are correct except:

A. Astrocytoma is usually malignant.

B. Ependimoma is usually benign.

C. Diffuse intrinsic pontine glioma is not amenable to surgical resection.

D. Atypical teratoma is highly malignant.

E. Craniopharyngioma is excised through trans-sphenoid approach.

Answer 4

A

Astrocytoma is usually benign.

Syed/MCQ

Question 5

Regarding vascular malformation of brain, which of the following is false?

A. For aneurysm, surgery is usually always needed.

B. Cavernous haemangioma if symptomatic requires surgery.

C. Incidental venous angioma should not be treated.

D. For large arteriovenous malformation, preoperative embolization is required.

E. Clipping of feeding vessels is ideal treatment for arteriovenous malformation.

Answer 5

E
Excision is ideal treatment for arteriovenous malformation. Clipping of feeding vessels without resection is treatment for residual malformation.

Syed/MCQ

Question 6

Regarding principles of chemotherapy, all of the following are false except:

A. Single-agent chemotherapy is better than combined chemotherapy.

B. Recovery of normal tissue takes average 7 days after chemotherapy, so interval is required.

C. Dose of chemotherapy is administered as minimum as possible.

D. Continuous administration for longer duration of chemotherapy is better than shorter the duration of administration.

E. Neoadjuvant chemotherapy is administered for residual disease after excision of tumour.

Answer 6

D

A longer duration of exposure of the tumour to a given cell cycle-specific agent might lead to greater efficacy.

Recovery of normal tissues takes an average of 21 days, so after chemotherapy, an interval is required.

Combination chemotherapy is better than single-agent chemotherapy, as not all the cells in the tumour are equally sensitive to chemotherapeutic agent.

Maximally tolerated dose should be administered. Dose intensity can be maximised by increasing the total dose of an agent or by shortening the time interval between the doses.

For a given increase in dose, a greater increase in tumour cell killing is achieved. For example, if the dose of cyclophosphamide is increased twofold, a tenfold increase in tumour cells killed can be observed.

Neoadjuvant chemotherapy is given before the operation to shrink the primary tumour and make surgical resection possible or less injurious or allow reduction of radiation field size or total dose.

Adjuvant chemotherapy is for no metastatic tumour after removal of the primary tumour. The goal of adjuvant chemotherapy is to eliminate disease not detectable by slandered radiographic means beyond the primary tumour site.

Syed/MCQ