An overview and introduction to brain tumors for Medical and Para medical students as well as Practitioners

1. Nikhil Govind
BPT
Brain tumors

2. Contents
 Definition
 Classification
 Signs and symptoms
 Investigations
 Medical management
 Surgical management

3. Definition:-
 A brain tumor is a growth of abnormal cells in the
brain
 It can be either malignant or benign

4. BENIGN
SLOW
GROWING
NON
CANCEROUS
DOES NOT
SPREAD TO THE
SURROUDING
TISSUES
MALIGNANT
CANCEROUS
FAST GROWING
AND
AGRESSIVE
CAN INVADE
NEAR BY
TISSUESAND
CAN REOCCUR
AFTER
TEARTMENT

5. LOCALISED INVASIVE
CONFINED TO
ONE AREA
EASIER TO
REMOVE
SPREAD TO
SURROUNDING
TISSUES
MORE
DIFFICULT TO
REMOVE
COMPLETELY

6. Classification:-
 It can be classified as follows primary tumor and
secondary tumors
 Primary Tumors consists of the following:-
 Gliomas
 Astrocytoma
 Ependymomas
 Medulloblastoma
 Pituitary adenomas
 Schwannomes
 Oligodendrogliomas
 Secondary tumors include :- metastatic tumors

7. Gliomas:-
 Gliomas are the primary tumours that arise from
supportive tissues of the brain located in the
cerebral hemispheres
 These tumours may also occur in the brain stem ,
optic nerve, spinal cord
 In children the cerebellum is the primary location
for gliomas
 Gliomas have four primary categories and are
classified by the predominant cellular
components

8.  They are classified in the follows such as
astrocytomas , oligodendrogliomas originate from
glial cells
 Ependymomas from epdymal cells and
medulloblastomas from primitive cells

9. Astrocytomas:-
 Astrocytoma are derived from astrocytes which
are star shaped glial cells and are the most
common primary brain tumors in adults and
children
 Astrocytomas are further classified into four
grades
 Low grade (grade1 and grade2)
 High grade anaplastic (grade3)
 Glioblastoma ,multiforme (grade4)
 The higher the grade poorer the prognosis

11. Low grade astrocytoma:-
 Grade i/ii astrocytomas make up to 14 % of all
primary intracranial tumors . The more frequent
grade 2 tumors occurs on an average of 35 years
 They are well differentiated astrocytic cells
 They are diffuse and slowly growing
 The pilocytic astrocytoma occurs in children and
young children in the hypothalamic region ,
cerebellum, and the brain stem they grow very
slowly and often stabilise or regress

12. High grade astrocytomas:-
 High grade astrocytomas include the grades of
grade 3 and grade 4
 Grade 3 is also known as anaplastic astrocytoma
they grow rapidly typically carry malignant cell
traits and routinely progress to grade 4
 Grade 4 is known as glioblastoma multiforma this
tumor grow rapidly invade nearby tissues and
contain highly malignant cells . Glioblastomas are
predominantly located in the deep white matter of
the cerebral hemispheres but may be found in the
brain stem ,cerebellum, or spinal cord

13. Oligodendrogliomas
 They are slow growing but progressive tumors
that typically develop over a period of several
years
 They slightly occur in a younger population 30-50
years and usually involve the frontal lobes
 Fifty percent of these tumors occur in the frontal
lobe 42% in the temporal lobe and 32% in the
parietal lobe
 The ratio which occurs is about 2:1 males to
female

15. Ependymomas:-
 Ependymomas are tumors arising from the
ependymal cells lining the ventricles that grow in
the ventricles or in adjacent tissue
 60% to 66% ependymomas are located in the
posterior fossa
 The majority arises in the 4 th ventricle occurs
more predominantly in the children population
 Most are low grade grade 2 but an anaplastic
form exists as well that is grade 3

17. Medulloblastomas:-
 They are malignant embryonal tumors thought to
arise from primitive neuroectodermal cells in the
granular layer of the cerebellum
 The tumors are typically located in the posterior fossa
originating laterally in the cerebrellar hemispheres in
young adults and vermis in children
 They typically grow in the fourth ventricle blocking csf
flow and causing hydrocephalus and increased ICP
 These tumors are most commonly in children
accounting for 25% of the childhood brain tumors

19. Meningioma
 They are slow growing tumors that primarily
originate from cells located in the dura matter or
arachnoid matter
 The ratio is about females to males 2:1
 They are slow growing
 These lie in greatest concentration around the
venous sinuses
 These present between the age of 40 to 60 years

21. Pituitary adenomas:-
 They are benign epithelial tumors originating from
the adenohypophysis of the pitutary gland and
frequently encroach the optic chiasm
 These tumors are characterised by
hypersecretion or hypo secretion of hormones
 It can occur at any age but pitutary adenomas are
rare before puberty
 the female to male ratio is 2:25:1

23. Schwannomas:-
 They are encapsulated tumors composed of
neoplastic Schwann cells that can arise on any cranial
nerve or spinal nerve
 The eight cranial nerve is the cranial nerve usually
involved and a schwannoma here is called an
acoustic schwannoma
 They usually present in the middle age 40-50 years
and occur more frequently in women
 They are slow growing tumors which arise from the
vestibular potion
 These tumors are typically located in the internal
auditory canal

25. Metastatic tumors:-
 They are secondary tumors that spread to the
brain typically spread to the brain typically
through the arterial circulation from a primary
systemic cancer site
 The frontal lobe is the most common site for
metastatic disease from primary systemic sources
including the lungs , breast and kidneys

27. Signs & symptoms
 Headaches
 Seizures
 Nausea
 Vomiting
 Fatigue
 Drowsiness
 Sleep problems
 Memory problems

28. Investigations:-
 Radiological diagnosis consists of tumor imaging
that has continued to develop and can be
classified into three categories
 1) static imaging
 2) dynamic imaging
 3) computer integration imaging

29. Static imaging:-
 Static imaging includes ct scan and MRI scan
which are the non invasive techniques that
provide accurate and functional analysis of
intracranial structures
 MRI:- MRI Is the initial diagnostic imaging
procedure of choice . MRI scanning is superior to
ct scanning in detecting and localising brain
tumors as well as evaluating edema,
hydrocephalus , haemorrhage

31. Dynamic imaging:-
 It includes the following PET (positive emission
tomography)
 Single photon emission computed tomography
(SPECT)
 Magnetic resonance spectography (MRS)
 Echo planar MRI

32. PET:-
 PET is a non invasive technique using a cyclotron
by using specific isotopes to obtain dynamic
information about the metabolism and physiology
of the brain tumor and the surrounding brain
tissue

33. SPECT:-
 SPECT is a functional imaging technique evolved
from PET that uses infused thallium which
localises in tumor but not in necrotic or normal
brain tissue
 SPECT is used to distinguish between low grade
and high grade tumors and between tumor re
occurrence and radiation necrosis

35. MRS:-
 MRS is a non invasive technique used in
conjugation with static MRI to measure the
metabolism of brain tumors
 MRS has been proved to differentiate
successfully normal brain between the malignant
brain

36. Echo planar MRI:-
 Echo planner MRI is a functional MRI Scanner
fitted with echo planar technology
 This technique maps cerebral blood flow at the
capillary level
 Its main information is to provide the diffusion of
contrast into tumors

37. Medical Management:-
 Afinitor
 Afinitor Disperz (Everolimus)
 Avastin (Bevacizumab)
 Bevacizumab
 BiCNU (Carmustine)
 Carmustine
 Carmustine Implant
 Everolimus

38. Surgical management:-
 Craniotomy :-
 Craniotomy is a surgery to cut a bony opening in
the skull . A section of the skull is called as bone
flap is removed to access the brain in the cases
of any brain tumors
 The craniotomy types depends on the severity of
the diseases

39. Types of craniotomy:-
 Extended BiFrontal Craniotomy:-The extended bifrontal
craniotomy is a traditional skull base approach used to target
difficult tumors toward the front of the brain
 Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy :-
Supra-orbital craniotomy (often called "eyebrow" craniotomy) is a
procedure used to remove brain tumors. In this procedure,
neurosurgeons make a small incision within the eyebrow to
access tumors in the front of the brain
 Retro-Sigmoid “Keyhole” Craniotomy:-Retro-sigmoid
craniotomy (often called "keyhole" craniotomy) is a minimally-
invasive surgical procedure performed to remove brain tumors.
This procedure allows for the removal of skull base tumors
through a small incision behind the ear, providing access to the
cerebellum and brainstem.
 It can be performed on acoustic neuromas , meninogiomas ,
metastatic tumors

40.  Orbitozygomatic Craniotomy:The orbitozygomatic
craniotomy is a traditional skull base approach used
to target difficult tumors and aneurysms
 Brain tumors that may be treated with orbitozygomatic
craniotomy include pituitary tumors and
meningiomas.
 trans labyrinthine Craniotomy:-A trans labyrinthine
craniotomy is a procedure that involves making an
incision in the scalp behind the ear, then removing the
mastoid bone and some of the inner ear bone
(specifically, the semicircular canals which contain
receptors for balance).
 Acoustic neuroma is treated by this technique

41. Radiotherapy:-
 Treatment of intracranial tumours with
radiotherapy utilises one of the following
 Megavoltage x ray
 Electron beam from a linear accelerator
 Accelerated particles from a cyclotron
 Treatment aims to provide the highest possible
dose to a specified region with minimising
irradiation to adjacent normal brain. Various
methods have been developed to achieve this-

42.  Conformal therapy:- A procedure that uses computers to create a 3-
dimensional picture of the tumor in order to target the tumor as
accurately as possible and give it the highest possible dose of radiation
while sparing normal tissue as much as possible. It is also known as 3-
D or conformational
 Sterostatic radiosurgeryereotactic radiosurgery :-(SRS) uses many
precisely focused radiation beams to treat tumors and other problems in
the brain, neck and other parts of the body. Stereotaxic radiosurgery is
completed in a single approach . It affects the DNA of the affected cells
 Proton therapy:- Proton therapy is a type of radiation treatment that
uses protons to treat cancer. It’s also called proton beam therapy. A
proton is a positively charged particle. At high energy, protons can
destroy cancer cells

43. CHEMOTHERAPY:-
 Chemotherapy is the use of drugs to destroy
cancer cells. It works by keeping the cancer cells
from growing and dividing to make more cells.
 Chemotherapy can be given by different methods
such as
 Injected chemotherapy;- the chemotherapy is
given in a shot in the muscle and reaches the
cancer site
 Oral chemotherapy

44.  Chemotherapy into an artery :- chemotherapy is
injected into an artery that goes directly to the
cancer. This is called intra-arterial or IA
chemotherapy.
 Topical chemotherapy :- this chemotherapy can
be given on the skin

45. Reference
 Darcy A Umphred
 K.W. Linsay

46.  THANK YOU