Property Neurosurgery Department, Department of General Surgery, Faculty of Medicine, University of Zagazig, Egypt

1. Brain tumorBrain tumor
OutlinesOutlines
 IntroductionIntroduction
 DefinitionDefinition
 Classification of brain tumorsClassification of brain tumors
 Risk factors for brain tumorsRisk factors for brain tumors
 Signs and symptoms of brain tumorSigns and symptoms of brain tumor
 Diagnosis of brain tumorDiagnosis of brain tumor
 Treatment of brain tumorTreatment of brain tumor
 Nursing managementNursing management

2. Brain tumorBrain tumor
IntroductionIntroduction

3. Brain tumorsBrain tumors

4. Brain tumorsBrain tumors

5. Brain tumorsBrain tumors

6. Definition of brain tumorDefinition of brain tumor
A brain tumor is aA brain tumor is a
localized intracraniallocalized intracranial
lesionlesion which occupieswhich occupies
space within the skullspace within the skull
and may cause aand may cause a riserise inin
intracranial pressure.intracranial pressure.

8. Incidence of tumorsIncidence of tumors
10-2510-25per 100.000 population per yearper 100.000 population per year
5-15%5-15%among all tumorsamong all tumors

9. •Tissue of origin
tumor location
•Primary or secondary (metastatic(
•Grading (benign or malignant(

10. Classification of brain tumorsClassification of brain tumors
1.1.Tumors of neuroepithelial tissueTumors of neuroepithelial tissue
►Astrocytic tumorsAstrocytic tumors
►Oligodendroglial tumorsOligodendroglial tumors
►Ependymal tumorsEpendymal tumors
►Mixed gliomasMixed gliomas
►Choroid plexus tumorsChoroid plexus tumors
►Neuronal and mixed neuronal-glial tumorsNeuronal and mixed neuronal-glial tumors
►Pineal parenchymal tumorsPineal parenchymal tumors
►Embryonal tumorsEmbryonal tumors

11. Classification of brain tumorsClassification of brain tumors
22Tumors of cranial and spinal nervesTumors of cranial and spinal nerves
33Tumors of the meningesTumors of the meninges
►Tumors of meningothelial cellsTumors of meningothelial cells
►Mesenchymal nonmeningothelial tumorsMesenchymal nonmeningothelial tumors
►Primary melanocytic lesionsPrimary melanocytic lesions
22Tumors of sellar regionTumors of sellar region
33Germ cell tumorsGerm cell tumors
44Lymphomas and hemopoietic neoplasmsLymphomas and hemopoietic neoplasms
55Cysts and tumor-like lesionsCysts and tumor-like lesions
66Local extensions from regional tumorsLocal extensions from regional tumors
77Metastatic tumorsMetastatic tumors
88Unclassified tumorsUnclassified tumors

12. Classification of brainClassification of brain
tumorstumors
Brain tumors can be benign or malignantBrain tumors can be benign or malignant
Benign brain tumors:Benign brain tumors:
 Benign brain tumorsBenign brain tumors do notdo not containcontain
cancer cells: usually, benign tumorscancer cells: usually, benign tumors
can be removed, and they seldomcan be removed, and they seldom
grow back.grow back.
 The border orThe border or edgeedge of a benign brainof a benign brain
tumor can be clearly seen. Cells fromtumor can be clearly seen. Cells from
benign tumors do not invade tissuesbenign tumors do not invade tissues
around them or spread to other partsaround them or spread to other parts
of the body.of the body.

13. Classification of brain tumorsClassification of brain tumors
(cont(cont……((
However, benign tumors canHowever, benign tumors can presspress onon
sensitive areas of the brain and causesensitive areas of the brain and cause
serious health problems.serious health problems.
 Unlike benign tumors in most otherUnlike benign tumors in most other
parts of the body, benign brain tumorsparts of the body, benign brain tumors
are sometimesare sometimes life threateninglife threatening ..
 Very rarely, a benign brain tumor mayVery rarely, a benign brain tumor may
becomebecome malignant.malignant.

14. Classification of brain tumorsClassification of brain tumors
(cont(cont……((
Malignant brain tumors:Malignant brain tumors:
 Malignant brain tumors are generallyMalignant brain tumors are generally
more serious and often is lifemore serious and often is life
threatening. It may bethreatening. It may be primaryprimary (the(the
tumor originate from the braintumor originate from the brain
tissue) ortissue) or secondarysecondary (metastasis(metastasis
from others tumor elsewhere in thefrom others tumor elsewhere in the
body).body).
 They are likely to growThey are likely to grow rapidlyrapidly andand
invade the surrounding healthy braininvade the surrounding healthy brain

15. Classification of brain tumorsClassification of brain tumors
(cont(cont……((
 Very rarely, cancer cells mayVery rarely, cancer cells may breakbreak
awayaway from a malignant brain tumorfrom a malignant brain tumor
and spread to other parts of theand spread to other parts of the
brain, to the spinal cord, or even tobrain, to the spinal cord, or even to
other parts of the body.other parts of the body.

16. Surgical classification of brainSurgical classification of brain
tumorstumors
IntracerebralIntracerebral
IntraventricularIntraventricular
ExtracerebralExtracerebral
SupratentorialSupratentorial
InfratentorialInfratentorial
Exact localization (lobes, basal ganglia, brainExact localization (lobes, basal ganglia, brain
stem, ventriclesstem, ventricles((

17. •Primary – unknown
•Metastatic
o35%-lung
o20%-breast
o10%-kidney
o5%-gastrointestinal tract

18. •Often unknown
•Under investigation:
oGenetic changes
oHeredity
oErrors in fetal development
oIonizing radiation
oElectromagnetic fields (including cellular phones(
oEnvironmental hazards (including diet(
oViruses
oInjury or immunosuppression

19. Risk factors of the brainRisk factors of the brain
tumortumor
 BBeing maleeing male
 AAgege
 FFamily historyamily history
 BBeing exposed to radiationeing exposed to radiation
or certain chemicals ator certain chemicals at
workwork

20.  Symptoms related to increased intracranialSymptoms related to increased intracranial
pressure such as:pressure such as:
 HeadacheHeadache most common in themost common in the
early morning and made worseearly morning and made worse
by coughing or strainingby coughing or straining
 Decrease in level ofDecrease in level of
consciousnessconsciousness such assuch as
confusion and lethargy.confusion and lethargy.
Signs and symptoms of brainSigns and symptoms of brain
tumortumor

21. Vomiting
Papilledema ( edema of
optic nerve) and visual
disturbance
Alteration in mental status.
Signs and symptoms of brain tumorSigns and symptoms of brain tumor
(cont(cont……((

22. Signs and symptoms of brain tumorSigns and symptoms of brain tumor
(cont(cont……((
Localized symptoms such as:Localized symptoms such as:
 AAphasiaphasia
 PPersonality changes as inersonality changes as in
case of frontal lobe tumorcase of frontal lobe tumor
 SSensory defects ( smell,ensory defects ( smell,
hearing).hearing).
 SSeizures.eizures.
 MMotor abnormalitiesotor abnormalities

23. •Cerebellar tumors
oDisturbances in coordination and equilibrium
•Pituitary tumors
oEndocrine
dysfunction
oVisual deficits
oHeadache

24. •Frontal Lobe
oInappropriate behavior
oPersonality changes
oInability to concentrate
oImpaired judgment
oMemory loss
oHeadache
oExpressive aphasia
oMotor dysfunctions

25. •Parietal lobe
oSensory deficits
Paresthesia
Loss of 2 pt discrimination
Visual field deficits
•Temporal lobe
oPsychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no
convulsions, but loss of consciousness
•Occipital lobe
oVisual disturbances

26. Diagnosis of brain tumorDiagnosis of brain tumor
 NNeurological examinationeurological examination
 BBrain CT scanrain CT scan
 MMRI on brainRI on brain
 AAngiogramngiogram
 BBiopsyiopsy

27. Neuroimaging of brain tumorsNeuroimaging of brain tumors
Major diagnostic modality. Useful forMajor diagnostic modality. Useful for
preoperative planningpreoperative planning
The diagnosis of a primary brain tumor is bestThe diagnosis of a primary brain tumor is best
made by cranial MRI. This should be the firstmade by cranial MRI. This should be the first
test obtained in a patient with signs or symptomstest obtained in a patient with signs or symptoms
suggestive of an intracranial mass. The MRIsuggestive of an intracranial mass. The MRI
scan should always be obtained both with andscan should always be obtained both with and
without contrast material (gadoliniumwithout contrast material (gadolinium(.(.
MRI superior to CT scan for evaluatingMRI superior to CT scan for evaluating
meninges, subarachnoid space, posterior fossameninges, subarachnoid space, posterior fossa
and defining the vascular abnormality of theand defining the vascular abnormality of the
lesionlesion

28. NeuroimagingNeuroimaging
High-grade or malignant gliomas appear asHigh-grade or malignant gliomas appear as
contrast-enhancing mass lesions, which arise incontrast-enhancing mass lesions, which arise in
white matter and are surrounded by edemawhite matter and are surrounded by edema
Multifocal malignant gliomas are seen in ~ 5% ofMultifocal malignant gliomas are seen in ~ 5% of
patientspatients..
Low-grade gliomas typically are nonenhancingLow-grade gliomas typically are nonenhancing
lesions that diffusely infiltrate brain tissue andlesions that diffusely infiltrate brain tissue and
may involve a large region of brain. Low-grademay involve a large region of brain. Low-grade
gliomas are usually best appreciated on T2-gliomas are usually best appreciated on T2-
weighted MRI scansweighted MRI scans..

29. NeuroimagingNeuroimaging
A contrast-enhanced CT scan may be used ifA contrast-enhanced CT scan may be used if
MRI is unavailable. CT may be false-negative inMRI is unavailable. CT may be false-negative in
patients with a low-grade tumor and can havepatients with a low-grade tumor and can have
significant artifact through the posterior fossa,significant artifact through the posterior fossa,
which may obscure a lesion in this areawhich may obscure a lesion in this area..
Calcification, which may suggest the diagnosisCalcification, which may suggest the diagnosis
of an oligodendroglioma, is often betterof an oligodendroglioma, is often better
appreciated on CT than on MRIappreciated on CT than on MRI..
CT useful if there is a question of bone orCT useful if there is a question of bone or
vascular involvement, or for detecting mets tovascular involvement, or for detecting mets to
skull base. Also, in ER situation or if MRI isskull base. Also, in ER situation or if MRI is
contraindicatedcontraindicated..

30. Brain Meningioma CTBrain Meningioma CT

31. Meningioma MRI /T2Meningioma MRI /T2

32. Coronal T1-weighted magnetic resonance imagesCoronal T1-weighted magnetic resonance images
show a parasagittal malignant meningioma (left) andshow a parasagittal malignant meningioma (left) and
its recurrence (right) 8 months after gross totalits recurrence (right) 8 months after gross total
resection and external beam radiation therapyresection and external beam radiation therapy..

34. PostcontrastPostcontrast
computedcomputed
tomographytomography
showing relativelyshowing relatively
homogeneoushomogeneous
enhancement inenhancement in
medulloblastomamedulloblastoma..

35. Radiologic features of metastaticRadiologic features of metastatic
diseasedisease
-Multiple lesions
-Localization at the grey-white
junction
-More circumscribed margins
-Relatively large amount of
edema compared to size of
lesion

36. Treatment of brain tumorTreatment of brain tumor
 A variety of medical treatmentA variety of medical treatment
modalities, includingmodalities, including
chemotherapychemotherapy and radiotherapy,and radiotherapy,
are used alone or in combinationare used alone or in combination
withwith surgical resectionsurgical resection ..
 Supportive care include:Supportive care include:
 SteroidsSteroids
 Anticonvulsant drugsAnticonvulsant drugs

37. •Damages DNA of rapidly dividing cells
•4000–6000Gy total dose
•Duration of 4–8 weeks
•Brachytherapy
•Stereotactic radiosurgery

38. •Slows cell growth
•Cytotoxic drugs
oCisplatin, Etoposide, Vincristine, Temozolomide
(Temodar(
•Ommaya Reservoir

39. Do you know whatDo you know what’’s in peoples in people’’s heads head??