2. 1. Introduction
2. Historical perspective
3. Types And Grade
4. Etiology and pathophysiology
5. Signs and Symptoms
6. Diagnosis
7. Treatment
8. Supportive Care
9. Rehabilitation
10.Outcome
11.Follow up
3.
4. Primary brain tumors occur in around 250,000 people a year globally, making up less than 2% of cancers[1]
BRAIN TUMOR-- A Brain Tumor is a collection, or mass, of abnormal cells in Brain.
tumor cells which is undifferentiated in the image
cells contain abnormal nuclei
abnormal cells form within the brain
many dividing cells: disorganized arrangement destroy healthy brain cells by invading them
[1]. ”Chapter 5.16” World Cancer Report 2014. World Health Organization. 2014. ISBN 978-9283204299. Archived from the original on 02 May 2019
5. brain tumor typically occur in 2 distinct categories
•
•
Children aged 0-15years
Adults in there 5th to 7th decade
•
•
Meningioma, a benign primary tumor - 33.8% of primary brain tumor
Glioblastoma Multiforme, a malignant tumor - 17.1% of adult primary tumor
• The largest percentage of childhood tumor i.e. 17% located in frontal,
parietal and occipital lobe followed by cerebellum (16%) and Brain Stem
(11%)
8.
nervous system may arise from
Cells of the coverings –
meninges, bone, subcutaneous
Cells intrinsic to the brain
Other cell populations within
the skull
Metastases (spread from
elsewhere in the body )
9. Classification
Based on source
Primary – originates from CNS
Secondary / metastatic – originates elsewhere in
body
Based on location
Supratentorial m/c in adults
Infratentorial m/c in pediatric age group
Tissue of origin
Glial :
Meningial :
Embryonal;
Mixed
Vascular
Bony origin
Tissue of origin Children Adults
Astrocytes
Pilocytic
Astrocytoma (PCA)
Glioblastoma
Multiforme (GBM)
Oligodendrocytes Oligodendroglioma
Ependyma Ependymoma
Neurons Medulloblastoma
Meninges Meningioma
10. Intra cranial/ intra axial
Extra dural
Intra dural (but outside parenchymal)
Intra parenchymal
Intra ventricular
Extra cranial
Calvarial bony tumours
Tumour arising from Skin and subcutaneoustissue.
11. Benign brain tumours
Benign brain tumours do not contain cancer cells : ‒
Usually, benign tumours can be removed and the rarely grow back. ‒ Benign
brain tumours have an obvious border or edge.
They dont spread to other parts of the body
They don't invade tissues around them
However, benign tumours can press on sensitive area of brain and can cause
serious neurological deficits.
Unlike benign tumour of other parts of the body, benign tumour of the brain
are sometimes life threatening
with time benign brain tumours can become malignant.
12. Malignant brain tumors.
contain cancer cells :
More serious and often are threat to life
Rapid Growth
Invade or crowd nearby healthy brain tissue
Cancer cell may spread to other parts of the brain or to the spinal cord
rarely spread to other parts of the body.
13. Metastatic BrainTumor
Originates from malignancies outside of the CNS and spread to the brain, typically through
arterial circulation. Approx. 25% of individual with systemic cancer develop metastatic brain tumor
approx.
80% in cerebral hemisphere and 20% in the posterior fossa.
1/3rd of brain metastases orginate in Lungs→ Breast→ Skin→ GI tract→Kidney
Frontal lobe is the most common site.
Average survival with the treatment is approx. 6 months but varies widely by the extent of other
systemic metastases.
14. CNSTumors:
General Features
10% of all tumors.
Commonest solid cancers in children.(2nd to
Leuk for all malignancies)
Age: double peak 1st& 6th decade
Adults - 70% supratentorial
Children - 70% infratentorial
No/very rare extra neural spread
Metastasis most common
Adults M/C location supratentorial
Children M/C location infratentorial
15. CLASSIFICATION OF CNSTUMOURS
1. TUMOURS OF THE GLIAL TISSUE – (GLIOMAS)
2. TUMOURS OF NEURONS
3. MIXED TUMOURS WITH GLIAL & NEURONAL COMPONENTS
4. POORLY DIFFERENTIATED AND EMBRYONAL TUMOURS
5. TUMOURS OF THE MENINGES
6. PERIPHERAL NERVE SHEATH TUMOURS
7. METASTATIC TUMOURS
8. PRIMARY CNS LYMPHOMA
9. Miscellaneous TUMOURS: angioma (vascular origin), pituitary adenoma,
17. RISK FACTOR
A risk factor is something that may increase the chance of getting a
disease.
Ionizing Radiations : especially from high dose x-rays and other sources
can cause cell damage that leads to a tumor. most common types are
meningioma or glioma.
Family History : It is rare for brain tumors to run in a family. only a very few
number of families have several member with brain tumors
19. Common
types of brain
tumors
GLIOMAS
Most common primary brain tumor
50% of all symptomatic brain tumors
Incidence increases with advancing age
Peak in 8th and 9th decades
No known environmental factors
No behavioural lifestyle choices
Ionizing radiation: the only clear risk factor
Originate from glial cells or their stem cell precursors
GLIOMAS Include
a. Astrocytoma
b. Oligodendroglioma
c. Ependymoma
20. Astrocytoma
Most common glioma
Cerebral astrocytoma (more in adults)
Behavioral changes
Seizures
Hemiparesis
Language difficulty
Cerebellar astrocytoma (more in children)
Hemiparesis
Ataxia
Brain stem (children
Pons
CN deficits
21. WHO Grading
of
Astrocytoma
Grade 1
Pilocystic astrocytoma
Bening cytological feactures
Survival >10 years
Grade 2
Low grade astrocytoma
Moderate cellularity – no aplasia or increase mitotic aactivity
Survival >5 years
Grade 3
Anaplastic astrocytoma
Increased cellularity, aplasia and mitotic activity
Survival 3 years
Grade 4
Glioblastoma multiforme
Fertures of grade 3 and microvascular proliferation and necrosis
Survival <1years
24. Oligodendroglioma
Derived from oligodendrocytes or their precursors
Oligodendrocytes produce the white matter in the brain
5-7% of all intracranial gliomas
Most often in the 3rd and 4th decades
Males:females = 2:1
Found primarily in cerebral hemispheres, within the brain parenchyma
Highly infiltrative
May metastasize distantly in ventricular & subarachnoid spaces like
the GBM (CSF seeding
Round regular “fried-egg” cells on histology
25. Prognosis of
Oligodendroglioma
Median Survival
Low-grade oligodendrogliomas:
8-16 years
Anaplastic oligodendrogliomas:
5 years
Tumours that have 1p/19q
LOH—best prognosis
Many pts die from malignant
transformation of the tumour
26. Ependymoma
Arise from ependymal cells (an intraventricular tumor)
More common in children
10% pediatric intracranial tumors
5% of adult intracranial tumors
Most common in the 4th ventricle
Ataxia, vertigo, increased ICP
May grow in brain parenchyma without obvious
attachment to the ventricular system
Spinal lesions more common in adults
Intracranial ependymomas predominate in children
27. Prognosis
5-year survival: 40-50
10-year survival: 47-68
Better prognosis
Young age
Infratentorial
Gross total excision
Low-grade histology
28. MENINGIOMA
Second most common primary brain tumor
Originate from arachnoid cells (meningoepithelial cap cells normally seen in arachnoid villi
20% of all intracranial tumors (with asymptomatic cases—40% or more
7% of all posterior fossa tumors
3-12% of cerebellopontine angle tumors
Most diagnosed in 6th % 7th decades
Female: Male—3:2 to 2:1
Multiple in 5-15% (NF-2
90% intracranial
10% intraspinal
Spinal meningioma: 10x in women
All familial meningiomas occur with NF-2
Rare in children (more in boys
Rare without dural attachments
Usually Intraventricular or posterior fossa
Commonly with sarcomatous changes
Frequently with NF-2
30. Sites of predilection
Cerebral convexity
(Sylvian & parasagittal
areas
Falxcerebri
Skull base
Olfactory groove
Sphenoid ridge
CP angle
Tuberculumsella
31. Pathology
• Nodular tumors occasionally
meningiomas (sheer-like formation)
• Highly vascular
• Encapsulated and attached in the
dura (blood supply from external carotid
artery
• Hyperostosis of adjacent bone (bone
proliferation
• Histological Characteristics
• Benign
• Typical features: Whorls of arachnoid cells
surrounding a central hyaline material that
eventually calcifies to form
PSAMMOMABODIES
32. ONCOGENES AND CNS
GROWTH FACTORS
sis, FGFs, CSFs, EGF, TGFα
RECEPTORS
TYROSINE KINASE- erbB, fms,
kit, ros, met, trk, neu
GROWTH HORMONE- mpl, epo
ANGIOTENSIN- mas
STEROID HORMONE- erbA
Second messenger signals
Transcription factors
fos, erb A, jun, myc, rel, myb, ets
Active transcription complex
TRANSDUCERS
ras, src, raf, mos, abl
Genes
CYTOPLASM
NUCLEUS
ONCOGENES
TUMOR SUPRESSOR GENES
33. VIRUSES
• RNA virus- oncorna family
Rous sarcoma virus, ASV, MSV, SSV
• DNA virus- Papovaviruses, Adenoviruses
(Bovine papilloma virus, Human JC virus, SV40)
NO CONCLUSIVE PROOF OF VIRAL INDUCTION OF HUMAN BRAIN
TUMORS
34. RADIATION- Fibrosarcoma, meningiomas, GBM (?)
• True incidence unknown
• Criteria
1. Tumor must occur within ports of radiation therapy
2. Adequate latent period must have elapsed
3. No other predisposing factors- NF, MEN
4. Definitive tumor diagnosis
5. Rarely occur spontaneously in control
35. CHEMICAL AGENTS
• Methylcholanthrene pellets- 1939
• Polycyclic hydrocarbons (PCHs)- gliomas (7-14 months),
depending upon location
• Alkylating agents- most commonly used agent gliomas
(oligodendrogliomas)
36. • Tumor associated-
• transplantation antigen, tumor specific antigen, viral antigen, fetal antigen
• Recognition
Proliferation
Effector
• Cellular immunity-
relative suppressor dominance, balance between helper & suppressor
• Humoral immunity
• Brain is an immunologically privileged site
• Immunologic response in brain tumor
• Host suppression
• Cytokines, MHC antigen
• Organ and organ related antigens
• Cellular infiltration
• Mechanism of suppression and blocking
37.
38. 1. Due to direct tissue destruction,
2. local brain infiltration or
3. secondary effect of increased ICP (Cushing’s triad)
Depends upon location-
positive ( headache/ seizure), negative symptoms (loss of
function)
Headache-
35% as first symptoms. 70% in growing tumor.
Associated with vomiting/ nausea, papilledema, focal cerebral signs
Facial pain- tumors at base of skull or nasopharynx
Seizure-
30% as first symptom.
98% in oligodendroglioma and 18% in mets
39. 0
• 3 times more common than primary brain tumor
• Often lodge- gray- white junction of cerebral, cerebellar hemisphere
• Commonly from lung, breast, kidney
• 2 major forms:
1. Single/ multiple well circumscribed deposits (commonest)
2. Carcinomatous meningitis
Leptomeningeal (breast, lung)
dural metastasis (non CNS lymphoma)
• Route- hematogenous/ direct/ CSF
• Abundant hemorrhage- melanoma, RCC, Chorioca
• Multiplicity common
• Retain primary characteristics
40. Signs and symptoms
Depend on tumor size, type and location.
Symptoms may be caused when a tumor presses on the nerve or harms the
part of the brain
Most common symptoms of brain tumors are :
Headaches (usually worse in the morning)
Nausea and vomiting
Changes in speech, vision, or hearing
Problems balancing or walking
Changes in mood, personality, or ability to concentrate
Problems with memory
Muscle jerking or twitching (seizures or convulsions)
Numbness or tingling in the arms or legs
41. Headache
presenting symptom in 30 % of the cases & devlops during the course of the
disease in 70% of the cases
It is important to identify the specific nature of the headaches, because certain
features often indicate the presence of a brain tumor. these feature include :
1. The headache that interrupts sleep or is worse on waking and improves
throughout the day
2. The headache that is elicited by postural changes, coughing, or exercise
3. The headache of recent onset that is more severe or of a different type than usual
4. The new onset of headache in a previously asymptomatic person
5. The headache associated with nausea and vomiting, papilledema, or focal
neurological signs
42. Seizure
Presenting symptom in 1/3rd of cases and is present in 50%-70% of cases
at some stage of the disease.
Approx 10%-20% adults with new onset seizure activity have brain tumors.
Seizures produce by glioma in
Frontal Lobe (59%)
Parietal Lobe (42%)
Temporal Lobe (35%)
Occipital Lobe (33%)
43. Altered Mental Status
The initial symptom in 15% to 20% of individuals.
Slight changes in concentration, memory, affect, personality, initiative, &
abstract reasoning to severe cognitive problems & confusion
44. Papilledema (Swelling of optic nerve)
less frequent now-a- days because brain tumors are being diagnosed
earlier with the use of sensitive imaging techniques.
It is more common in children with slow growing tumors and posterior
fossa tumors.
Other less common symptoms are vomiting and frank positional vertigo,
usually accompanying tumors found in the posterior fossa
45. Specific Signs & Symptoms
Few Clinical features are related to functional areas of the brain thus have
a specific localizing value in medically diagnosing a brain tumor.
FRONTAL LOBE Functions : Motor functioning, initiation of action, and
interpretention of emotion, including motor speech. motor praxis,
attention, cognition, emotions, intellegence, judgement, motivation and
memory.
Disorders : Hemiparesis, Seizures, Aphasia & Gait Difficulties.
With gowth of tumor there may be personality changes like Disinhibition,
Irritability, Impaired Judgement, & Lack of Initiation
46. PARITAL LOBE
Functions : It processes complex sensory & perceptual infomation
related to somesthetic sensation, spatial relations, booody schema, &
praxis.
General Condition : Contralateral Sensory loss & hemiparesis,
Homonymous visual deficits or neglect, agnosias, apraxias & visual-spatial
disorders.
If Dominant Parital Lobe is involved, Aphasia & may be present.
If Non-Dominant Parietal Lobe is Involved, Contralateral neglect &
decresed awareness of impairements can commonly be found.
47. OCCIPITAL LOBE
• Functions : It is primary processing area of visual information.
• General Condition : Dysfunction of the eye movement & Homonymous
hemianopsia. If parieto- occipital junction is involved, visual agnosia &
agraphia are often present.
• Bilateral tumor may cause Cortical Blindness.
48. TEMPORAL LOBE
Functions : Auditory and limbic processing. Condition :
Ant. lesion - clinically silent until they become very large and causing
seizes.
Lateral Side - Auditory and perceptual changes Medial Side - Changes in
cognitive integration,
long-term memory, learning, and emotions may be seen.
Dominant Temporal lobe - Aphasia
Left Temporal lobe lesion - Anomia, agraphia, acalculia, Wernicke aphasia
(Fluent, nonsensical speech)
Bitemporal involvement - It is rare and causes memory deficits & possible
dementia.
49. CEREBELLUM
Function : Coordination & Equilibrium.
Common Symptoms : In adults, headache, nausea and vomiting present in
40% of condition & ataxia in 25% of Cases.
Lesion of midline - Truncal & Gait Ataxia
Lesion of Hemispheres - Uni. Appendicular ataxia mostly in UE
Lesion of either Hemisphere - Ipsilateral dysmetria,
dysdiadochokinesia, and intention tremor.
Lesion in cerebellopontine angle - hearing loss,
headache, ataxia, dizziness, tinnitus and facial palsy may occur.
If tumor invades meninges the at foramen magnum causes cerebellar tonsil herniation,
nuchal rigidity and head tilt away from lesion may be seen.
** As cerebellum is located in an extremely confined space, even minimal increases in
pressure can cause death from cerebellar tonsil herniation.
50. BRAIN STEM
Function : It communicates information to and from the cerebral cortex via
fiber tracts, control basic life function. Reticular formation specifically controls
consciousness and attention.
Symptoms : Tumor have an insidious onset and may include gait
disturbances, diplopia, focal weakness, headache, vomiting, facial
numbness and weakness, and perrsonality changes.
Dorsal Midbrain - Parinaud Syndrome(Loss of upward gaze, pupillary
areflexia to light, and loss of convergence)
Reticular System of Pons & Medulla - Apnea,
hypo- or hyper- ventilation, orthostic hypotension or syncope
51. PITUITARY GLAND
Functions : It secretes hormones that regulate many bodily
process
Condition : Tumors are typically large and affect pitutary
function by compressing its structure or
hypersecreting hormones.
•Enlarging tumor decreases the hormone production resulting in
Pituitary disorders are specific to type of hormones involved e.g.
Cushings disease, hypothyroidism, addisodisease, diabetes etc.
•As tumor enlarge it compresses nearby area :
• Lateral Extension -
•
•
•
3rd & 4th cranial nerve - Diplopia
5th Nerve - Ipsilateral Facial Numbeness
Internal Carotid artery occlusion - Cerebral
Infarction
•
•
Upward Extension - Compresses Optic Chiasma &
Hypothalamus
Downward Extension - Compresses Sphenoid Sinus
52.
53. Diagnosis
A clinical diagnosis consist of information the physician gathers during a
comprehensive examination.
Medical History including the specific nature of S&S
Neurological Examination - Testing of reflexes & assess visual, cognitive,
sensory, and motor function.
Opthalmic examination – papiloedema, pupillary light reflex, visual acuity and
Visual Feild
After clinical diagnosis suspects the tumor the next diagnostic step is Tumor
Imaging
54. Radiological Diagnosis
Static neurological imaging includes CT and MRI,
Noninvasive techniques
Provide accurate anatomical and functional analysis of intracranial structures.
CT Scan :
CT uses ionizing radiation, thin bands of x-rays, to produce images of slices of brain
tissue.
It was the first brain imaging technique to allow determination of tumor size.
Contrast enhancement helps to identify isodense tumor from surrounding
parenchyma, hypodense lesions in edematous areas, and optimal sites for tumor
biopsy.
After surgical intervention, CT can be used to confirm the proper tissue biopsy site and
determine the success of tumor resection.
Although MRI has become the preferred method, CT scanning offers lower cost, a
shorter scanning time, and a more sensitive method to detect calcification and bony
involvement.
55. Magnetic Resonance Imaging :
• MRI is the imaging procedure of choice
• MRI is superior to CT in detecting & localizing tumor as well as
evaluating edema, hydrocephalus or hemorrhage.
• MRI is more sensitive imaging modality
• Contrast enhancement with gadolinium sharpens the definition of
lesion
• MRI enhanced with gadolinium can distinguish between edema
and tumor
56.
Positron emission tomography (PET)
Single photon emission CT (SPECT)
Magnetic Resonance Spectroscopy (MRS)
Functional MRI PET Scan
It is non-invasive and uses cyclotron and specific isotopes to obtain info about
metabolism and physiology of the tumor and surrounding tissue.
It uses radioactive markers to measure glucose metabolism which is useful to
determine the grade of primary brain tumor.
It also helps in study of metabolic effect of chemotherrapy, Radiation therapy and
steroids on the tumor.
It is expensive & less reliable in patient with heavy dose of chemo therapy
57.
It is functional imaging technique evolved from PET scan & uses
isotopes w/o cyclotron to assess cerebral blood flow and determining
tumor location.
It is used to identify high- & low- grade tumor to differentiate between
tumor
recurrence and radiation necrosis.
for biopsy.
SPECT is less sensitive method to obtain physiological information on
tumors.
It is more readily available and less expensive.
It is used pre-op with static imaging to localize highest metabolic
area of tumor
58. It is a non-invasive technique used in conjunction with static MRI to measure the
metabolism of brain tumors.
It has been proved to differentiate successfully normal brain from malignant
tumor and recurrent tumor from radiation necrosis.
It also has been used to document early treatment response and provide information
regarding histological grade of astrocytomas.
Magnetic resonance angiography (MRA) generates images of blood vessels without
dye or ionizing radiation to evaluate the blood flow and position of vessels leading to
the brain tumor.
Magnetic Resonance Spectroscopy :
59. It uses a conventional MRI scanner fitted with echo planar technology to map cerebral
blood flow at the capillary level.
Its intended purpose is to provide information regarding the diffusion of contrast into
tumor, resulting in better resolution of tumor and edema.
It can also be used to identify the motor, sensory, and language areas of the brain or the
functional eloquent cortex
Functional Magnetic Resonance Imaging:
60.
Surgical biopsy is performed to obtain tumor tissue as part of tumor resection
or as a separate diagnostic procedure.
Stereotactic biopsy is a computer-directed needle biopsy.
When guided by advanced imaging tools, stereotactic biopsy yields the lowest
surgical morbidity and highest degree of diagnostic information.
This technique is frequently used with deep-seated tumors in functionally important
or inaccessible areas of the brain in order to preserve function.
61. Laboratory Diagnosis
Laboratory testing is often used to further assess focal deficits during the diagnosis and
management of brain tumors.
Perimetry is the measurement of visual fields used when evaluating tumors near the optic chiasm.
Electroencephalography (EEG) is used to monitor brain activity and detect seizures but has limited
value during screening because EEG findings are often normal in clients with brain tumors.
Lumbar puncture is used to analyze CSF, which is useful in the diagnosis and detection of
dissemination of certain brain tumors.
Audiometry and vestibular testing are useful for diagnosing tumors in the cerebellopontine
angle.
Endocrine testing is used to examine endocrine abnormalities with tumors in the pituitary gland and
hypothalamus.
62. TREATMENT
Medical & Surgical Management
The ultimate goal of tumor management are to improve quality of life and
extend survival, by improving body function & structures
Treatment techniques are determined by histological type, location, grade,
and size of tumor; age of onset; and medical history of the patient.
Four Type of Treatment are discussed :
1. Traditional Surgery
2. Chemotherapy
3. Radiation Therapy
4. Stereotactic Radiosurgery
63. Primary Goal : Maximal tumor resection with the least amount of damage to neural
or supporting structures.
The purposes of surgery in the management of brain tumors include the following :
1. Biopsy to establish a diagnosis
2.Partial resection to decrease the tumor mass to be treated by other
methods
3. Complete resection of the tumor
4. Provision of access for adjuvant treatment techniques.
64. Biopsies are performed through open, needle, and stereotactic needle techniques.
‒Open biopsies involve exposure of the tumor followed by removal of a sample through
surgical excision.
‒Needle biopsies involve insertion a needle into the tumor through a hole in the skull
and the excision of the tissue sample drawn through the needle.
‒Stereotactic needle biopsies use computers and MRI or CT scanning equipment to
assisst in directing the needle into the tumor.
Partial & Complete Resections are accomplished through craniotomy.
–Craniotomy involves removal of a portion of the skull and seperation of
the dura mater to expose the tumor.
–Stereotactic craniotomy uses technologyto guide neurosurgeon
duing the procedure.
–Awake craniotomy allows for intra-op brain mapping.
65. Preoperative Management : Before surgery, clients are evaluated for
general surgical risks and the possibility of tumors in additional
locations.
Unless medically contraindicated, steroids & anticonvulsant
medications are administered before surgery
Intraoperative Management : During surgery, precautions are taken to
prevent an increase in edema or ICP.
Mannitol(vasodiuretic) &Hyperventilation is used to
decrease ICP,
Steroid use is continued and
Antibiotics are administered to prevent infection.
66. Postoperative Management : Patients are observed in an intensive care unit for at least 24
hours for possible intracranial bleeding or seizures. Blood pressure is monitored
continuously.
Post-op these patients are more prone to DVT but due to the risk of
intracranial bleeding, acoagulants cannot be given so Compression stockings are used
prophylactically.
Steroids are tapered in 5-10 days post-op.
The Primary Limitations of traditional surgery include :
1. Medical Complication such as Hematoma, Hydrocephalus, infection,
infarction from procedure.
2. Complications resulting from GA
3. Increased cost of hospital stay and surgical procedure.
67. It can be used independently or as an adjuvant to surgery or radiation.
Chemotherapy can be administered in a number of different ways.
•Most agents are given intravenously through a peripheral intravenous line or through a
catheter such as a peripherally inserted central catheter (PICC).
•Chemotherapy drugs impede cellular replication of the tumor cells, interfering with their
ability to copy deoxyribonucleic acid (DNA)
and reproduce.
• Methotrexate (Highly neuro-toxic) is admnistered with Leucovorin (Antidote)
• Temozolomide is orally available chemotherapeutic agent for the Rx of Gliomas.
• The antiangiogenesis monoclonal antibody Avastin (bevacizumab) improved the
progression- free survival and the tumor images on MRIs of patients with glioblastoma.
The drug targets vascular endothelial growth factor (VEGF) and is administered
intravenously.
68. RADIATIONTHERAPY :
It can be used alone or in conjunction with surgery or chemotherapy to
treat malignant brain tumors.
It is typically chosen as a treatment option for tumors that are too large or
inaccessible for surgical resection and to eradicate residual neoplastic cells
after a surgical debulking.
Radiotherapy consists of the delivery of high-powered photons, with
energies in a much greater range than that of standard x-rays, as an
external beam directly at the tumor site.
69. Radiosurgery
Radiosurgery involves
relatively high-dose
hypofractionated radiation
beams directed at small
tumor areas through the
use of computer imaging.
This type of treatment
includes the Gamma Knife,
linear accelerators, and
the cyberknife.
70. •
•
Stereotactic radiosurgery is defined as delivery of a high dose of
ionizing radiation, in a single fraction, to a small, precisely defined
volume of tissue.
The high-energy accelerators involved with stereotactic
radiosurgery improve the physical effect of radiation by allowing
energy to travel more precisely in a straight line and penetrate
deeper before dissipating.
• The goal of stereotactic radiosurgery is to arrest tumor
growth.
• Advantages of stereotactic radiosurgery are as follows:
1.Is a noninvasive procedure using local anesthesia and
sedation to place the stereotactic frame
2.Avoids risks of general anesthesia and immediate
postoperative risks such as bleeding, CSF leak, and
infection
3. Lowers treatment cost and shortens hospital stays.
71. • A brain tumor and its treatment can lead to other health problems. You may
receive supportive care to prevent or control these problems.
•
•
You can have supportive care before, during, and after cancer treatment.
It can improve your comfort and quality of life during treatment.
Health care team help you with following problems :
Swelling of the Brain Seizures
Fluid buildup in the skull Sadness and other feeling
** Many people with brain tumors receive supportive care
along with treatments intended to slow the progress of the
disease. Some decide not to have antitumor treatment and
receive only supportive care to manage their symptoms.
