brain tumor

1. BRAIN TUMOR

2. • A brain tumor or intracranial neoplasm occurs when
abnormal cells form within the brains

3. INCIDENCE
• In india 3-4 per 100,000 persons per year.
• Males have slightly higher incidence

4. TYPES
• Primary : arising from tissues within the brain
• Secondary : resulting from a metastasis from a malignant
neoplasm elsewhere in the body.

5. • Brain tumors are generally classified according to the
tissue from which they arise. The most common primary
brain tumors originate in astrocytes. These tumors are
called gliomas.

6. Glioma
• Astrocytoma --- astrocytes
• Glioblastoma --- primitive stem cell, glioblast
• Oligodendroglioma --- oligodendrocytes
• Ependymoma --- ependymal epithelium
• Medulloblastoma --- primitive neuroectodermal cell

7. • Meningioma – meninges
• Schwannoma
• Pituitary adenoma – pituatory gland
• Hemangio blastoma – blood vessels of brain
• Primary CNS lymphoma – lymphocytes

8. Clinical manifestations
• CM depends on the location, size and mitotic rate of
the cells of the tissue of origin.
• Headache – worse at night
• Seizures
• Nausea, vomiting and increased ICP
• Cognitive dysfunction – Memory problems, mood or
personality changes
• Muscle weakness

9. • Sensory losses
• Aphasia
• Visuospatial dysfunction
• Cerebral edema

10. Complications
• Hydrocephalus – tumor mass obstructs the ventricles or
occludes the outlet.
• Assignment :
• Ventriculo atrial shunt
• Ventriculo peritoneal shunt

11. Diagnostic studies
• History and PE
• A new onset seizure indicate presence of brain tumor
• MRI, PET – detection of tumors
• CT scan , Brain scanning
• EEG
• Lumbar Puncture
• Angiography

12. • Computer guided stereotactic biopsy

13. Management
• Aim :
• Identifying the tumor type and location.
• Removing or decreasing tumor mass.
• Preventing or managing ICP.

14. • Surgical therapy
• Radiation therapy
• Chemotherapy

15. Surgical therapy
• Surgical removal is the preferred treatment for brain
tumors.
• Computer guided stereotactic biopsy, ultrasound,
functional MRI and cortical mapping can be used to
localize brain tumors intraoperatively. Complete surgical
removal is not always possible bcoz the tumor is not
always accessible or it has involved vital parts of the
brain.

16. Stereotactic surgery
• Stereotactic surgery uses precision apparatus(often
computer guided) to assist the surgeon to precisely target
an area of the brain.
• Stereotactic biopsy can be performed to obtain tissue
samples for histologic examination.
• CT scanning and MRI are used to image the targeted
tissue.
• With the patient under general or local anesthesia the
surgeon drills a burr hole or creates a bony flap for an
entry site and then introduces a probe and biopsy needle.
• Stereotactic procedures are used for removal of small
brain tumors and abscesses.

17. • A major advantage of this is a reduction in damage to
surrounding tissue.
• Stereotactic radiosurgery is a procedure that involves
closed skull destruction of an intracranial target using
ionizing radiation focused with the assistance of an
intracranial guiding device.
• The dose of radiation can be delivered over a single 4 to 6
hour treatment time.

18. Radiation therapy
• Cerebral edema and increased ICP may be a
complication of radiation therapy, but they can be
managed with high doses of corticosteroids
• Stereotactic radiosurgery is a method of delivering a high
concentrated dose of radiation precisely directed at a
location within the brain.

19. Chemotherapy
• Chemotherapeutic drug : nitrosoureas are used to treat
brain tumors.
• Chemotherapyladen biogradable wafers(gliadel wafer)
implanted at the time of surgery can deliver chemotherapy
directly to the tumor site.
• Methotrexate

20. • Temozolomide is the first oral chemotherapeutic agent.

21. Brain surgery
• Burr hole :
• opening into the cranium with a drill; used to
remove localized fluid and blood beneath the dura.
• Craniotomy :
• opening into the cranium with removal of a
bone flap and opening the dura to remove a lesion, repair
a damaged area, drain blood or relieve increased ICP.
• Craniectomy :
• excision into the cranium to cut away a
bone flap.

22. • Cranioplasty :
• Repair of a cranial defect resulting from
trauma, malformation, or previous surgical procedure,
artificial material used to replace damaged or lost bone.
• Stereotaxis:
• precision localization of a specific area of the
brain using a frame or a frameless system based on 3
dimensional coordinates; procedure is used for biopsy,
radiosurgery or dissection.

23. • Shunt procedures :
• Alternate pathway to redirect
cerebrospinal fluid from one area to another using a tube
or implantable device; eg: venriculoperitoneal shunt

24. • Cortical stimulation mapping (often shortened to CSM) is
a type of electrocorticography that involves a physically
invasive procedure and aims to localize the function of
specific brain regions through direct electrical stimulation
of the cerebral cortex.