Tumor

Question 1

What are the most common pineal region tumors to be seen in adults?

Answer 1

Pineocytoma

Question 2

Synchronous primary intracranial germ cell tumor is a subset of what tumor type that occurs in what two distinct intracranial locations?

Answer 2

Germinoma

Pineal region and suprasellar region

Symptoms more often in line with endocrinolgic abnormalities from suprasellar tumor

Question 3

The middle fossa approach to a intracanalicular vestibular schwannoma leads to early identification of what structure compared to RMC approach?

Answer 3

Distal facial nerve

Question 4

Glycogen invagination into cellular nuclei appears as what on histological staining of many meningiomas?

Answer 4

Vacuoloization (clear intracellular spaces)

Question 5

What are verocay bodies?

Answer 5

Groups of pallisading nuclei around an eosinophillic core seen in schwannomas

Question 6

WHO I skull base meningiomas achieve what probability of control at 5 years after a single dose of SRS?

Answer 6

91-95%

Question 7

What is a sensitive indicator of CN VIII function in BAER intra-operative neurophys?

Answer 7

Wave I-V latency

Question 8

What is Ramsay-Hunt Syndrome (Zoster oticus)?

Answer 8

Sudden onset right facial paralysis, ear pain, nystagmus, loss of balance. May see linear enhancement in IAC extending to tympanic segment of facial nerve

Question 9

What is the function of the protein, Merlin, which is mutated in NF2?

Answer 9

Tumor suppressor gene

Question 10

During awake craniotomy which lobe has a high risk of intraoperative seizures?

Answer 10

Frontal (counter-intuitive but based on research)

Question 11

What values define a cure of acromegaly for IGF-1 and GH?

Answer 11

IGF1 normalization postop

GH values less than 0.4 ug/L after oral glucose load

Question 12

BRAF V600E mutations are often found in what intracranial brain tumor?

Answer 12

Gangliogliomas

Question 13

In newly identified posterior fossa lesions what imaging finding confers a greater risk of seizure development?

Answer 13

Hydrocephalus

Question 14

Broca’s area is near pars orbitalis, opercularis, or triagnularis?

Answer 14

Pars opercularis

Question 15

Describe why the anterior condylar vein is an important landmark

Answer 15

During a far lateral approach, removing more occipital condyle lateral to this implies 1/3 to 1/2 is being taken which can lead to occipito-atlanto instability

Question 16

What other tumor type also looks like a fried-egg appearance?

Answer 16

Central neurocytoma

Question 17

What type of cells do paragangliomas originate from?
Where are they commonly located?
Sporadic or familial?
What are some symptoms and cranial nerves involved at the above locations?
What may they secrete?

Answer 17

• Chromaffin cells from neuroectoderm
• Carotid body, glomus jugulare, tympanic cavity
• Mostly sporadic, 25% familial pattern
• Carotid body may have involvement of CN X with hoarseness or Horner’s syndrome from compression on adjacent carotid body; Glomus jugulare may involve CN IX, X, XI; Glomus tympanicum with pulsatile tinnitus and conductive hearing loss
• May secrete norepinephrine causing symptoms such as HTN, headaches, sweating, palpitations

Question 18

What is the best treatment strategy for esthesioneuroblastoma without lympatic or metastatic spread?

Answer 18

Surgical resection followed by conformational radiation therapy

Question 19

Why is it not a great idea to give SRS or fractionated radiotherapy to patients with small vestibular schwannomas and servicable hearing?

Answer 19

Radiation may accelerate the hearing loss. A period of initial observation is warranted

Question 20

What operative tool increases the likelihood of complete resection in GBM?

Answer 20

Intra-op MRI

Question 21

When treated with SRS and WBRT for metastatic disease what is the likelihood of cognitive decline?

Answer 21

50%

Question 22

What are some factors on imaging associated with increased risk of perilesional edema after SRS?

Answer 22

Larger tumor volume, presence of pretreatment edema, presence of multiple sclerosis, and marginal dose of > 14 Gy

Question 23

What is the Knosp grading system?

Answer 23

A system using coronal MRI images to grade parasellar extension of pituitary/sellar masses based on lateral extension and cavernous sinus involvement

Question 24

What is neurocysticercosis caused by?

Answer 24

Taenia soleum

Question 25

Relatively reduced CBF around a neoplastic lesion in an elderly patient points towards …

Answer 25

Primary CNS Lymphoma

Question 26

Staghorn conformation of surrounding vessels is a buzzword for what tumor?
How aggressive are they?

Answer 26

Hemangiopericytomas

Very aggressive, they invade local bone and may even metastasize