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Brain Tumours.Dr NG NeuroEdu

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  • 1. Brain Tumours Nishantha Gunasekera MBBS MS MRCSNeuroSurgEducation2009NG
  • 2. Types of CNS Tumours1.Tumours of Neuroepithelial tissue2.Tumours of Cranial nerves3.Tumours of the Meninges4.Haemopoetic Neoplasms5.Germ cell tumours6.Cysts and tumour like lesions7.Tumours of the sellar region8.Local extensions from regional tumours9.Metastatic tumours
  • 3. ClassificationA. Neuroepithelial tumours1.Astrocytes - Astrocytoma (I, II,III,GBM)2.Oligodendrocytes - Oligodendroglioma (low grade, high grade)3.Ependymocytes - Ependymoma4.Mixed gliomas5.Choroid plexus6.Neuroepithelial tumours of uncertain origin7.Neurons8.Pinealocytes9.Embryonal tumours
  • 4. B. Tumours of the Meninges 1. Tumours of the meningothelial cells Syncytial, fibrous, transitional: Angioblastic, atypical, malignant 1. Mesenchymal, non meningothelial cell tumours lipoma, osteoma C. Tumours of the Cranial and spinal nerves 1. Schwannomas- Vestibular 2. Neurofibromas 3. Malignant Peripheral Nerve sheath Tumours (MPNST)NeuroSurgEducation2009
  • 5. D. Haemopoetic neoplasms and Lymphomas 1. Malignant lymphomas (primary CNS) 2. Plasmacytoma 3. Granulocytic sarcoma E. Germ cell tumours 1. Germinoma 2. Embryonal carcinoma 3. Yolk sac tumour 4. Choriocarcinoma 5. TeratomaNeuroSurgEducation 6. Mixed GCT2009 NG
  • 6. F. Cysts and tumour like lesions1. Rathke’s cleft cyst2. Epidermoid (cholesteatoma)3. Dermoid4. Colloid cyst of III5. Enerogenous cyst6. Neuroglial cyst7. Granular cell tumour8. Hypothalamic neruonal hamartoma9. Plasma cell granuloma
  • 7. G. Tumours of the sellar region1. Adenohypophyseal cells – pituitary adenomas2. Pituitary carcinoma3. CraniopharyngiomaH. Local extension from regional tumours1. Paraganglioma2. Notochord- chordoma3. Chondroma4. Carcinoma
  • 8. I. Intracranial embryonal remnants Adipose cells- lipomas of corpus callosumJ. Metastatic tumoursK. Unclassified
  • 9. Brain Tumours
  • 10. Brain Tumours
  • 11. Brain Tumours
  • 12. Brain TumoursNeuroSurgEducation2009NG
  • 13. Brain Tumours What are the symptoms and signs? What investigations need to be done Is it benign or is it malignant What surgery can be done What is the post op care What is the histology What adjuvant therapy needs to be given What complications can arise What follow up needs to be done
  • 14. Symptoms and signs Headache Vomiting RAISED ICP! Papilloedema Others nausea weakness balance memory eye movement co-ordination siezures smell altered LOC frontal features vision sudden death urinary incontinence hearing weight problems gait issues
  • 15. Investigations  Basic simple tests  CT  MRI  fMRI  PET  TractographyNeuroSurgEducation2009NG
  • 16. NeuroSurgEducation2009NG
  • 17. NeuroEducation2009
  • 18. NeuroEducation2009
  • 19. NeuroEducation2009
  • 20. NeuroEducation2009
  • 21. NeuroEducation2009
  • 22. NeuroEducation2009
  • 23. NeuroSurgEducation2009NZ
  • 24. Low GradeNeuroSurgEducation2009NG
  • 25. GBMNeuroEducation2009NG
  • 26. NeuroEducation2009
  • 27. NeuroEducation2009
  • 28. NeuroEducation2009
  • 29. NeuroSurgEducation2009
  • 30. Surgery Depends on  Site  Malignant vs benign  Primary vs metastatic  Clinical and Radiological diagnosis  General condition of the patient  Co-morbiditiesNeuroSurgEducation2009NG
  • 31. Options  Burrhole biopsy  Craniotomy and excision/debulking Neuronavigation (stealth)
  • 32. NeuroSurgEducation2009NG
  • 33. NeuroEducation2009
  • 34. BurrholeNeuroSurgNG
  • 35. BurrholeNeuroSurgEducation2009NG
  • 36. Craniotomy - Pterional approachNeuroSurgEducation2009NG
  • 37. Supratentorial approachNeuroSurgEducation2009NG
  • 38. Infratentorial approachNishantha Gunasekera
  • 39. Closed surgical sitesNeuroSurgEducation2009NG
  • 40. Other Therapy Radio therapy Chemotherapy Steroids Antiepileptics Analgesics
  • 41. Post Op Brain swelling Altered level of conciousness Bleeding (EDH, SDH, ICH) Siezures Weakness Vision Cranial nerve palsies Infection
  • 42. Follow up Recurrence of malignant tumours Recurrence of meningiomas Delayed post op complications (flap, csf, siezures) Chemo/Radio issues