（22-1）颅内肿瘤.ppt

1、Intracranial Tumors Primary Arising from intracranial tissues Metastatic Transfered from other system or organs Adult： Account for 1.8% of all cancers Children: 20%,胶质瘤,脑膜瘤,垂体瘤,Epidemiology studies have not indicated any particular factors( viral, chemical or traumatic) that cause brain tumors in hu

2、mans although a range of cerebral tumor can be induced in animals experimentlly.,Aetiology,Classification of brain tumors (WHO, 2007),1.神经上皮组织肿瘤 Tumors of neuroepithelial tissue 1 星形细胞瘤 Astrocytoma 2 少枝胶质细胞肿瘤Oligodendroglial tumors 3 室管膜细胞肿瘤 Ependymal tumors 2 颅神经和脊旁神经肿瘤 Tumors of cranial and parasp

3、inal Nerves 雪旺氏细胞瘤(神经鞘瘤) Schwannoma (Neurilemmoma) 3 脑膜组织肿瘤 Tumors of the Meninges 脑膜瘤 Meningioma 4 淋巴瘤和造血细胞肿瘤 5 生殖细胞肿瘤 Germ Cell Tumors 6 鞍区肿瘤 Tumors of the Sellar Region 垂体腺瘤 Pituitary adenoma 7 转移性肿瘤 Metastatic Tumors,Epidemiology of brain tumor Primary intracranial tumor Incidence 7.8-12.5/100 t

4、housands Average 10/100 thousands Metastatic tumor Incidence 2.1-11.1/100 thousands,Relative Incidence,The distribution of brain tumor on ages,Presentation of brain tumor The most common presentation of brain tumor is progressive neurologic deficit(68%), usually motor weakness(45%). Symptoms and sig

5、ns of increased intracranial pressure ： headache vomiting optic disc edema Focal neurologic deficits associated with brain tumors,.1 those due to increased ICP A. from mass effect of tumor and /or edema B. from blockage of CSF drainage (hydrocephalus),Signs and symptoms include,2 progessive focal de

6、ficits: include weakness, dysphasia(which 37%-58% of patients with left-sided brain tumor) A due to destruction of brain parenchyma by tumor invasion B due to compression of brain parenchyma by mass and/or peritumoral edema C due to compression of cranial nerve,3. Headache,4 seizures: not infrequent

7、ly the first symptom of a brain tumor Tumor should be aggressively sought in an idiopathic first time seizure in patient 20 years ( if negative, the patient should be followed with repeat studies at later dates）,5 Mental status changes depression lethargy apathy,6. Symptoms suggestive of a TIAor str

8、oke may be due to : A . occlusion of a vessel by tumor cells B . hemorrhage into the tumor : any tumor may hemorrhage , C . focal seizure,7 in the special case of pituitary tumor A symptoms due to endocrine disturbances B pituitary apoplexy C CSF leak,Focal neurologic deficits associated with brain

9、tumor,In addition to nonfocal signs and symptoms ( seizures, increased ICP) Frontal lobe: abulia, dementia, personality changes. Often nonlateralizing, but apraxia, hemiparesis or dysphasia( with dominant hemisphere involement ) may occur Temporal lobe: auditory or olfactory hallucinations, memory i

10、mpairment. Contralateral superior quadrantanopsia may be detected on visual field testing.,3. Parietal lobe: contralateral motor or sensory impairment, homonymous hemianopsia, Agnosias (with dominant hemisphere involvement) and apraxias may occur 4. Occipital lobe: contralateral visual field deficit

11、, alexia(especially with corpus callosum involvement with infiltrating tumors 5. Posterior fossa : cranial nerve deficits, ataxia(truncal or appendicular ),Diagnosis of a brain tumor The diagnosis of brain tumors include three steps A Whether B What C Where 1 Clinical diagnosis history and signs 2 I

12、mage investigations CT MRI DSA PET,Differentiate Diagnosis brain abscess parasitic infection brain hemorrhage brain infarction benign increased ICP,Treatment of brain tumors 1 Relieve increased ICP 2 Operation 3 Radiation therapy 4 Chemotherapy 5 GAMMA-knife,Glioma Glioma comprise the majority of br

13、ain tumors and arise from the neuroglial cells derived from neuroectodermal origin There are four types of glial cells : Astrocytes Oligodendroglia Ependymal cells Neuroglial precursor,Astrocytoma (WHO grade I or II) The most common neuroepithelial tumor invade diffusely and have no distinct tumor m

14、argin. Location ： may arise in any part of the brain Adult ：cerebrum Children ：cerebellum Anaplastic astrocytoma, Glioblastoma (Malignant, WHO III orIV) ) grow more aggressively and can invade more cerebral lobes, even invade over midline.,Astrocytoma,Glioblastoma,Clinical presentation Raised ICP Fo

15、cal neurological signs Epilepsy Diagnosis Clinical presentation CT MRI,Treatment : Operation : primary Radiation therapy: prolong the survival time Chemotherapy Prognosis：depend on the location of the tumor Median survival Astrocytoma: aboute over 5 years Anaplastic : 2-3 years glioblastoma: 1 years

16、,Medulloblastoma One of the most malignant brain tumor ( may seed in the subarachnoid cavity) location ：cerebelar vermis age：before 10 years old Clinical presentation： Increased ICP Ataxia Teatment：surgery radiation therapy chemotherapy Prognosis：5-year survival is above 30%以上，the best 80%.,Meningio

17、ma Arise from arachnoid (not dura), slow growing, extra-axial, usually benign, circumscribed(non-infiltrating). Account for 14.319% Peak incidence 45 years age Female:male ratio 1.8 : 1,Meningioma,1。May occur anywhere that arachnoi cells are found, most commonly located along falx, convexity, or sph

18、enoid bone 2。Usually cured (if completely removed, which is not always possible ）. 3。Malignant incidence 1.7% of meningiomas 4。Multiple 8% of cases (more common in Neurofibromatosis),Treatment Surgery Radiation therapy Ineffective as primary modality of treatment Efficacy in preventing recurrence is

19、 controversial,Outcome 5 year survival for patients with meningioma 91.3%,Pituitary adenoma,Pituitary adenoma arise from the anterior gland (adenohypophysis) May be classified by endocrine function routine histological staining method electron microscopic apperance Microadenoma: a pituitary adenoma

20、1cm diameter,Pituitary adenoma,Clinical presentation of pituitary adenoma,Functional Non-functional,Functional,Prolactin(PRL) : Prolactinomas are the most common secretory adenoma. Amenorrhea-falactorrhea syndrome(Forbes- Albright) in females Impotence in males,Adrenocorticotropic hormone （ACTH) Cus

21、hings disease : endogenous hypercortisolism Growth hormone(GH) Acromegaly in adults Gigantism in children Rare pituitary adenomas secrete thyrotropin (TSH) : produce thyrotoxicosis gonadotropins (LH or FSH): no clinical syndrom,Non-functional pituitary adenoma,Mass effects of pituitary adenomas Opti

22、c chiasm: classically resulting in bitemporal hemianopsia Pituitary gland:resulting in varying degrees of hypopituitarism Hypothyroidism: cold intolerance, myxedema, coarse hair Hypoadrenalism: orthostatic hypotension, easy fatigability Hypogonadisn: amenorrhea, loss of libido, infertility Diabetes

23、insipidus Hyperprolatctinemia: PRL is under inhibitory control from the hypothalamus,Diagnosis of pituitary adenomas,History and physical Endocrine hyperfunction Endocrine deficits Visual field deficits Deficits of cranial nerves,Endocrinologic evaluation Baseline endocrine evaluation Specialized en

24、docrinologic tests Radiaogrphic evaluation MRI CT,Treatment,Medical treatment ,PRL Adenoma Dopamine agonists: bromocriptine Surgical treatment transsphenoidal transcranial approaches Radiationtherapy,Acoustic neurinoma,Arise from the superior vestibular division of the 8th nerve 3 most common early

25、symptoms hearing loss(insidious and progressive) tinnitus dysequilibrium Other symptoms including : headache facial numbness facial weakness diplopia nausea and vomiting,Acoustic neurinoma,Diagnosis,Audiometric and audiologic studies Radiographic evaluation,Treatment,Surgery Radiation alone conjunction with surgery,