Brain tumour mindmap

1. Brain tumour
epidemiology
second to leukaemia
in children
adults
supratentorial
children infratentorial
clinical presentation
progressive
neurological
deficit-mass effect
symptoms of raised
intracranial pressure
early morning headache, vomiting
seizure
hydrocephalus
haemorrhage
endocrine
disturbance
asymptomatic
investigation
Hx
physical exam.
imaging
CT as screening but MRI best
functional imaging
fMRI
PET
+/- CSF cytology
Treatment
aids to resection
functional MRI
surgical navigation
systems
open MRI
awake craniotomy
pre-operative
embolisation
adjunctive
treatments
radiation therapy
ionising radiation injuries DNA
tumour tissue more
susceptible than normal
tissue
prolong survival for gliomas
e.g. gamma knife
radiosurgery pre and 1 yr
post
chemotherapy
works for PCNSL
works for gliomas esp oligodendrogliomas
with 1p19q chromosome deletions
temozolomide
prolong survival for
glioblastoma pts
biological therapies
experimental
gene therapy
diptheria toxins
conjugated to antibodies
anti-angiogenesis agents
Childhood tumours
second most common
childhood
tumour-19%; #1
leukaemia 37%
commonest solid
tumour
astrocytoma>medullablastoma>ependymoma
astrocytoma-most
common, benign,
90% cure
30% of paediatric
posterior tumours
5-10 yrs
medullablastoma
arise in the cerebellar vermis
it's a primitive
neruectodermal tumour
extremely malignant
seed aling CSF pathways
mets to spinal axis
ependymoma
arise from cells that line
the ventricles or the
central canal of spinal
cord
in children and young adults
diffuse brain stem tumour
these tumours balloon the
brain stem and infiltrate
all layers
malignant;poor prognosis
cause cerebellar
dysfunction, cranial nerve
palsies and paresis
adult primary tumour
glial most common 60%
astrocyticdevelop into anaplastic
astrocytoma
develop in to glioblastoma
multiforme
pathology-necrosis
therapy
maximal tolerated
durgical resection
histopahtological
postoperative scan
external beam
radiotherapy
chemotherapy
histologically at
recurrence
concurrent chemoradiation
with temozolomide is new
standard of care
oligodendroglial(low vs
high grade)
occurs in the cerebrum
slow growing
middle age adults
mixed O-A
role of chemo. in gliomas
terms
neo-adjuvant(prior to RT)
concurrent(during RT)
adjuvant(after RT)
salvage(at recurrence)
obstacles
delivery
BBB: oral, IV, IT,
intracavitary wafers,
convection-enhanced
delivery
resistance(MGMT for
alkylating agenst)
genomic instability
meningioma 20%
pituitary, pineal 10%
neuronal,PCNSL
etc-> rare tumours
10%
nerve tumours
types
meningioma
extra-axial=outside the
arachnoid
primarily a surgical disease
classified by location
for residual or recurrent
meningioma us radiation
and/or focused radiation
vestibular
schwannoma
arise from cranial nerve VIII
slowly progressive hearing loss
bilateral NF2
surgery or focused
radiation
pituitary adenoma
non-functioning(present
with visual symptoms,
headache,
hypopituitarism)
functioning
prolactin(galactorrhoea, infertility)
ACTH(cushing's
syndrome)
Txdrugs, surgery, radiation
primary CNS
lymphoma
in immunosuppressed personsAIDS, organ transplant
rate rising irrespective of
immune suppression
treated with biopsy and chemo
metastasis
greatly outnumber
primary tumour of brain
from
lung cancer>40%
breast 40%
renal cell 7%
- - Mindjet