Brain Tumours             Nishantha Gunasekera               MBBS MS MRCSNeuroSurgEducation2009NG
Types of CNS Tumours1.Tumours of Neuroepithelial tissue2.Tumours of Cranial nerves3.Tumours of the Meninges4.Haemopoetic N...
ClassificationA. Neuroepithelial tumours1.Astrocytes          - Astrocytoma (I, II,III,GBM)2.Oligodendrocytes    - Oligode...
B. Tumours of the Meninges     1. Tumours of the meningothelial cells              Syncytial, fibrous, transitional: Angio...
D. Haemopoetic neoplasms and Lymphomas    1. Malignant lymphomas (primary CNS)    2. Plasmacytoma    3. Granulocytic sarco...
F. Cysts and tumour like lesions1. Rathke’s cleft cyst2. Epidermoid (cholesteatoma)3. Dermoid4. Colloid cyst of III5. Ener...
G. Tumours of the sellar region1. Adenohypophyseal cells – pituitary adenomas2. Pituitary carcinoma3. CraniopharyngiomaH. ...
I. Intracranial embryonal remnants   Adipose cells- lipomas of corpus callosumJ. Metastatic tumoursK. Unclassified
Brain Tumours
Brain Tumours
Brain Tumours
Brain TumoursNeuroSurgEducation2009NG
Brain Tumours   What are the symptoms and signs?   What investigations need to be done   Is it benign or is it malignan...
Symptoms and signs   Headache   Vomiting               RAISED ICP!   Papilloedema   Others    nausea                 w...
Investigations           Basic simple tests           CT           MRI           fMRI           PET           Tracto...
NeuroSurgEducation2009NG
NeuroEducation2009
NeuroEducation2009
NeuroEducation2009
NeuroEducation2009
NeuroEducation2009
NeuroEducation2009
NeuroSurgEducation2009NZ
Low      GradeNeuroSurgEducation2009NG
GBMNeuroEducation2009NG
NeuroEducation2009
NeuroEducation2009
NeuroEducation2009
NeuroSurgEducation2009
Surgery     Depends on      Site      Malignant vs benign      Primary vs metastatic      Clinical and Radiological di...
Options  Burrhole biopsy  Craniotomy and excision/debulking Neuronavigation (stealth)
NeuroSurgEducation2009NG
NeuroEducation2009
BurrholeNeuroSurgNG
BurrholeNeuroSurgEducation2009NG
Craniotomy - Pterional approachNeuroSurgEducation2009NG
Supratentorial approachNeuroSurgEducation2009NG
Infratentorial approachNishantha Gunasekera
Closed surgical sitesNeuroSurgEducation2009NG
Other Therapy   Radio therapy   Chemotherapy   Steroids   Antiepileptics   Analgesics
Post Op   Brain swelling   Altered level of conciousness   Bleeding (EDH, SDH, ICH)   Siezures   Weakness   Vision ...
Follow up   Recurrence of malignant tumours   Recurrence of meningiomas   Delayed post op complications (flap, csf,    ...
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
Brain Tumours.Dr NG NeuroEdu
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Brain Tumours.Dr NG NeuroEdu

  1. 1. Brain Tumours Nishantha Gunasekera MBBS MS MRCSNeuroSurgEducation2009NG
  2. 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. 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. 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. 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. 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. 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. 8. I. Intracranial embryonal remnants Adipose cells- lipomas of corpus callosumJ. Metastatic tumoursK. Unclassified
  9. 9. Brain Tumours
  10. 10. Brain Tumours
  11. 11. Brain Tumours
  12. 12. Brain TumoursNeuroSurgEducation2009NG
  13. 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. 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. 15. Investigations  Basic simple tests  CT  MRI  fMRI  PET  TractographyNeuroSurgEducation2009NG
  16. 16. NeuroSurgEducation2009NG
  17. 17. NeuroEducation2009
  18. 18. NeuroEducation2009
  19. 19. NeuroEducation2009
  20. 20. NeuroEducation2009
  21. 21. NeuroEducation2009
  22. 22. NeuroEducation2009
  23. 23. NeuroSurgEducation2009NZ
  24. 24. Low GradeNeuroSurgEducation2009NG
  25. 25. GBMNeuroEducation2009NG
  26. 26. NeuroEducation2009
  27. 27. NeuroEducation2009
  28. 28. NeuroEducation2009
  29. 29. NeuroSurgEducation2009
  30. 30. Surgery Depends on  Site  Malignant vs benign  Primary vs metastatic  Clinical and Radiological diagnosis  General condition of the patient  Co-morbiditiesNeuroSurgEducation2009NG
  31. 31. Options  Burrhole biopsy  Craniotomy and excision/debulking Neuronavigation (stealth)
  32. 32. NeuroSurgEducation2009NG
  33. 33. NeuroEducation2009
  34. 34. BurrholeNeuroSurgNG
  35. 35. BurrholeNeuroSurgEducation2009NG
  36. 36. Craniotomy - Pterional approachNeuroSurgEducation2009NG
  37. 37. Supratentorial approachNeuroSurgEducation2009NG
  38. 38. Infratentorial approachNishantha Gunasekera
  39. 39. Closed surgical sitesNeuroSurgEducation2009NG
  40. 40. Other Therapy Radio therapy Chemotherapy Steroids Antiepileptics Analgesics
  41. 41. Post Op Brain swelling Altered level of conciousness Bleeding (EDH, SDH, ICH) Siezures Weakness Vision Cranial nerve palsies Infection
  42. 42. Follow up Recurrence of malignant tumours Recurrence of meningiomas Delayed post op complications (flap, csf, siezures) Chemo/Radio issues

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