brain tumor with pathophysiology and management

1. BRAIN TUMOR
Ms. Shany Thomas, Asst.Professor, MSN

2. A brain tumor is a localized intracranial lesion
that occupies space within the skull.

3. Broad Classification
 Primary
 Secondary

4. According to Tissue of origine
1.Glioma : with in the brain tissue
 Astrocytoma – Low to moderate grade
Malignancy
 Glioblastoma – Highly malignant and
invasive
 Oligodendroma- Benign
 Ependymoma - Benign or Highly
Malignant

5. 2.Meningioma -Benign or Malignant
3.Acoustic neuroma -Benign or law grade
malignancy
4.Pituitary Adenoma -Benign
5.Haemangioblastoma - Rare and benign
6.Primary CNS Lymphoma
7.Metastatic Tumors

6. Etiology
 No clear factor
 Familial tendency
 Immuno suppression
 Environmental factors
 Research studies shows use of cellular
phones, hair dyes, head trauma can lead to
brain tumors

7. PATHOPHYSIOLOGY
(Monrokellies Hypothesis)
Fast Growing Tumor
Increased ICP
Compensatory
mechanism
Reduction in volume of blood and CSF

8.  Initial Compensatory Mechanism
Displacement of CSF in to Spinal cord and
Subarachnoid space
Impairment of venous drainage
Venous congestion and papileedema

9. Secondary Compensatory Mechanism
Reduction in blood volume
Hypoxia
Ischemia

10. Tumor growth
Compression of veins Increased venous
pressure
Decreased absorption Increased capillary
of CSF permeability
Cerebral edema

11. Last Stage of Compensation
Increased ICP
Displacement of Brain Tissue
Death

12. Clinical Features
The Traid of Clinical features
 Head ache
 Nausea/Vomiting
 Papilledema
- Mental Status Changes
- Seizures

13. Localized Manifestations
 Focal Weakness
 Sensory disturbances
 Language disturbances
 Coordination disturbances
 Visual disturbances

14. FUNCTIONAL AREAS OF BRAIN

15. Frontal lobe
One side paralysis
Seizures,
defective memory,
impaired judgement,
personality changes
Temporal lobe
Occasional seizures
Language disorders
Brain stem
Uncoordinated walk
Muscle weakness
Difficulty in speech
Drowsiness
Hearing loss
Parietal lobe
Seizures
Speech disturbance
Loss of ability to write
Occipital lobe
Blindness
seizures
Cerebellum
Vomiting
Head ache
Uncoordinated
muscle movement
Problems in walking

16. Diagnostic Findings
 CT Scan
 MRI
 X Ray
 EEG
 Angiogram
 Lumbar puncture
 Steriotactic Biopsy
 PET Scan

17.  CT Scan

18. Management
Surgical management
 Craniotomy: surgically creating an opening in to the skull
 Burr Hole: Opening the cranium with a drill
 Craniectomy: Excision in to the cranium to cut away a
bone flap
 Cranioplasty: Repair of cranial defect, using artificial
materials to replace lost bone
 Stereotaxis: It uses computer guided apparatus to
precisely target an area of the brain
 Shunt procedures: redirecting CSF from one area to
another

21. Transsphenoidal Hypophysectomy

22. Chemotherapy
Commonly used drugs
 Temozolomide: oral chemotherapeutic agent
 Nitrosoureas-: Carmustine, lomustine
 Inj Mannitol

23. Radiation Therapy
 Interstitial radiation
 Stereotactic radio surgery
 Radiation sensitizing
therapy
 Intraoperative radiation
 Radioactive monoclonal
antibodies

24.  Nursing Diagnosis
1. Impaired tissue perfusion related to cerebral
edema
2. Acute pain related to cerebral edema and
increased ICP
3. Self care deficit related to neuromuscular
dysfunction
4. Anxiety
5. Risk for altered cerebral tissue perfusion
6. Ineffective individual coping
7. Risk for altered thought process
8. Anticipatory grief