intracranial tumors presentation final

1. INTRACRANIAL
TUMOURS
Moderators:
Dr. S. S. Karbhari
Dr. Nitin Tengli
Dr. Rohit Devani
Presenter:
Dr. Abhishek Y

2. Secondary brain tumour

3. Primary brain tumours
• 1. GLIOMA (43%)
a. Astrocytomas are the commonest type.
They are usually malignant.
They can occur anywhere in the cerebral
hemispheres, Medulla, brainstem
Peak incidence is fourth decade
They can be diffused, solid, or cystic.
They contain star shaped cells resembling adult
neuroglial cells. Astrocytomas are graded has grades
I, II, III, IV based on the quantity of adult and primitive

4. • Grade 1 – cystic
• Grade 2 – defuse
• Grade 3 – anaplastic
• Grade 4- glioblastoma multiforme- High-grade
aggressive type of astrocytoma. Treated by surgical
removal/debulking; high dose radiotherapy,
chemotherapy with carmustine inserted into the
surgical cavity and oral Tamezolomide.

6. c. Oligodendrogliomas
• They are slow growing tumour commonly arising
from frontal lobes
• lasts for years
• shows calcification.

7. d. Spongioblastoma polare
• They arise from primitive spongioblasts affects optic
chiasma, 3rd ventricle, hypo- thalamus.
• They are both operable and radiosensitive.

8. d. Medulloblastoma
• It is highly malignant embryonal tumour grouped
under PNETs (primitive neuro- ectodermal tumours)
arising from primitive cell nests;
• common in children (medulloblastoma is the most
common brain tumour in children) and young
individuals.
• It often spreads within the brain itself causing
sugarcoat metastases which may extend across the
spinal canal.

9. Ependymomas
• Here cells resemble ependymal cells;
• can occur throughout the hemispheres.
• They arise from cells lining the ventricles of the
brain and central canal of the spinal cord.
• They are common in 4th ventricle;
• common in younger individual;
• blocks CSF circulation. causing hydrocephalous.

10. 2. Meningiomas (18%)
• They are usually globular, arising from the arachnoids.
• Tumour gets attached to the dura.
• It gets blood supply from dural arteries and veins, from emissary veins and veins of diploe and scalp.
• Along these veins tumour cells invade the bone, causing bone destruction and reactive hyperostosis.
• Meningiomas are classified as fibroblastic, endothelial and angioblastic.
 Sites:
1. Parasagittal
2. Frontobasal
3. Posterior fossa
4. Choroid plexus

11. Meningioma
• Microscopic:It
contains whorls of
spindle cells, with
central hyaline
material, with
psammoma bodies.
• CT/MRI diagnostic
• Surgery is the choice
therapy
• It has got good
prognosis

12. 3. Schwannoma
• Common in auditory nerve,
also called as acoustic
neuroma.
• Occurs in the internal
auditory meatus which
projects into the
cerebellopontine angle (C- P
angle), compressing 5, 6, 7,
8th nerves.
• It presents with compressive
features like unilateral
deafness, trigeminal

13. 4. Pituitary tumours (12%)
5. Craniopharyngioma (5%)
6. Blood vessel tumours (2%)

14. Clinical features of primary brain
tumour
• Initial period of silent growth.
• Focal seizures with epilepsy.
• Raised intracranial pressure with headache,
vomiting,deterioration of level of consciousness,
altered vision, slowpulse, high BP, papilloedema.
• Brain displacement and stage of coning.

15. Specific features of primary brain
tumour
• Frontal lobe tumours: Personality and emotional
changes, epilepsy of generalised type, contralateral
facial weakness.
• Parietal lobe tumours: Jacksonian epilepsy,
progressive hemiparesis, astereognosis, acalculia.
• Occipital lobe tumours:Aura of flashing of light in
contralateral field, homonymous hemianopia.
• Temporal lobe tumours: Progressive aphasia,
visual, auditory, smell and taste hallucinations,
hemiparesis, superiorquandrantic hemianopia.

16. • Midline tumours: Produces bilateral
hydrocephalus.
• Tumours of the third ventricle (colloid cyst is
common):Causes bilateral hydrocephalus,
progressive cerebralatrophy, dementia, sexual
precocity, endocrine disturbances.
• Pineal tumours: Causes precocious puberty.
• Cerebellar vermis tumours: Usually
medulloblastomas, occur in young children,
presents with progressive hydrocephalus and
features of herniation of cerebellar tonsils through
foramen magnum.
• Cerebellar hemisphere tumours: Commonly are

17. Investigations
• X-ray skull
• Calcifications likein meningiomas,
craniopharyngiomas.
• Separation of sutures. A beaten silver
appearance. Lateral displacement of
pineal body. Hyperostosis, expansion,
destruction in skull bones
• Isotope scan.
• CTscan.
• MRI.
• Positron Emission Tomography (PET).
• Carotid angiogram (Introduced by Egas Moniz).
• Ventriculography.
• EEG.

19. Treatment
oRelief of raised intracranial pressure:
a. Ventricular tap and drainage through the posterior
parietal burr hole
b. Tapping of cystic tumours and abscess
c. Emergency decompression by partial removal of
tumours
d. Steroid therapy-dexamethasone
oEstablishment of pathological diagnosis:
a. Burr hole And biopsy
b. Craniotomy and biopsy using brain cannula.
c. Frozen section biopsy.

20. • Removal of benign tumours—by different
craniotomy approaches.
• Decompressive surgeries for malignant tumours.
• Shunt surgeries to drain CSF—ventriculoperitoneal
shunt or ventriculoatrial shunt.
• Radiotherapy—external radiotherapy is used as
primary treatment or as an adjuvant therapy after
surgery.
• Chemotherapy is occasionally used—
Temozolamide.
• Tumour which is benign and surgically accessible
has better prognosis

21. PITUITARY TUMOURS
Classification 1
1. Eosinophil (Acidophil) adenomas:
• Tumour is usually small.
• Rarely it causes compressive features.
• It secretes excess growth hormone causing acromegaly in adults and gigantism in children.
2. Chromophobe adenomas
• common in females and in the age group—20–50 years.
• Initially, it is intrasellar and after sometime becomes suprasellar. Later, it extends intracranially often
massively, causing features of intracranial space occupying lesion.
• It presents with myxoedema, amenorrhoea, infertility, headache, visual disturbances, bitemporal
hemianopia, blindness, intracranial hypertension, epilepsy.
• Differential diagnosis: Meningiomas, aneurysms.CT scan, angiogram, X-ray skull are diagnostic.
• Treatment is surgical decompression by craniotomy through subfrontal approach or trans-sphenoidal
approach.
• Deep external radiotherapy and steroids are also used.
.

22. 3. Basophil adenomas are usually small.
• They secrete ACTH and presents as Cushing’s disease with all its features.
4. Prolactin-secreting adenomas cause infertility, amenorrhoea and
galactorrhoea

23. Classification II
• Hypersecreting
• Hyposecreting by compression and atrophy
Classification III
• Micronodular: Tumour size less than 10 mm
• Macronodular: Tumour size more than 10 mm
Stages
• Stage of intrasellar development
• Stage of suprasellar extension
• Stage of massive intracranial extension

24. • Investigations
• X-ray skull—shows calcifications, destruction of
sella turcica, mass lesion, enlarged pituitary fossa.
• CTscan.
• MRI.
• Hormone assay—like serum prolactin, growth
hormone, ACTH,steroids, sex hormones, etc.
Treatment
• Surgery: By subfrontal craniotomy approach or
transphenoidal approach.Care should be taken not
to injure optic chiasma, arteries, cavernous sinus.
• External radiotherapy.

25. • Pituitary apoplexy is the syndrome associated with
haemorrhagic infarction of a pituitary tumour.
• It presents with sudden headache, visual loss and
ophthalmoplegia with or without impaired
conscious level.
• Endocrine resuscitation with intravenous steroids
is the priority, and surgical decompression may be
required.

26. CRANIOPHARYNGIOMAS
• They are large masses with cystic cavities, lined
by ciliated epithelium containing cholesterol
crystals.
• Areas of calcifications may be present and coral-
like masses may be formed.
• They are adherent to the basal arteries and
adjacent nerves.
• They are irremovable.
• They are tumours of sellar region.

27. • Clinical Features
• Intrasellar craniopharyngiomas inhibits sexual
maturation causing obese, impotent dwarf with
bitemporal hemianopia (due to compression of
optic chiasma)—Frolich’s syndrome.
• Suprasellar craniopharyngiomas produces Frolich’s
syndrome; pressure on hypothalamus which
controls sleep and water metabo- lism (causes
somnolence and diabetes insipidus).
• Massive intracranial extension causes intracranial
hypertension and also hydrocephalus by
obstructing CSF flow.

28. • Investigations
• Skull X-ray shows calcification.
• CT scan is diagnostic.
• Treatment
• Through craniotomy or through trans-sphenoidal approach
cystic tumours are evacuated.
• Ventriculoatrial shunt has to be done to drain CSF in case of
hydrocephalus.
• Ventriculocisternostomy—Torkildsen’s operation is done in
cases of large masses blocking the 3rd ventricle obstructing
the CSF outflow.

29. THANK YOU