BY AKSHAY MAURYA

BRAIN TUMOR
• A primary brain tumor is
a group (mass) of
abnormal cells that start
In the brain.

• A brain tumor is a
localized intracranial
lesion that occupies
space within the skull.
Tumors usually grow as a
spherical mass, but they
can grow diffusely and
infiltrate tissue. The
effects of neoplasm occur
from the compression and
infiltration of tissue.
 Brain Tumor
• Benign
– May have aggressive tendencies
– May transition to more aggressive lesion
– Tends to be slower growing
• Primary malignant
– Age distribution for various tumors
– Impact due to mass effect or invasion
• Metastatic
– History of pre-existing neoplasm
– May be primary presentation
 pathophysiologic events
• Increased
intracranial
pressure (ICP) and
cerebral edema
• Seizure activity
and focal
neurologic signs
• Hydrocephalus
• Altered pituitary
function
 CAUSE
• unknown
RISK FACTORS

• Exposure to
ionizing
radiation
• Head injuries
• Smoking
Astrocytoma

• Irregular low
attenuation
lesion (CT)
• Isodense to
gray matter
central area
• Relatively ‘low
grade’
• Surrounding
edema (black)
Astrocytoma
• MRI
• Parietal
lesion
• White
representing T2 T2

surrounding
edema on T2
images
• Contrast
enhancement
on T1+C
T1 T1+C
Meningioma
• Medial
posterior mass
adjacent to the T2 T1

meninges
• Slow growing
• Minimal mass
effect
• Intense
enhancement
T1+C T1+C
 Meningioma
• Extra-axial lesion
• Impact based on mass effect
• May be quite large without symptoms
 Cystic Astrocytoma
• Cystic mass in posterior fossa
• Rim and mural nodule enhancement on
contrast – far right image at arrows
 Metastatic
Brain
Tumor
T2
• Multiple ring PD

enhancing
lesions
• Brain edema
(white rim T2)
• Known lung
T1
cancer T1+C
Lung Neoplasm

• Nodule
upper right
lung field
• Patent with
brain
metastases
Dermoid cyst
MRI
 DIAGNOSTIC TEST
• Computed tomography (CT) scan
-Can give specific information concerning the
number, size, and density of the lesions and the
extent of secondary cerebral edema
-Can provide information about the ventricular
system

• Magnetic resonance imaging (MRI)

-Is the most helpful diagnostic tool for detecting
brain tumors, particularly smaller lesions, and
tumors in the brain stem and pituitary region,
where bone interferes with CT

• Positron emission tomography (PET)

-It is used to supplement MRI
-Low grade tumors are associated with
hypometabolism and high-grade tumors show
hypermetabolism
-This information can be useful in treatment
decisions
DIAGNOSTIC TEST
• Computer-assisted stereotactic (three-
dimensional) biopsy
-Used to diagnose deep-seated brain
tumors and to provide a basis for
treatment and prognosis
• Cerebral angiography
-Provides visualization of cerebral blood
vessels and can localize most cerebral
tumors
• Electroencephalogram (EEG)
-Can detect an abnormal brain wave in
regions occupied by a tumor and is used
to evaluate temporal lobe seizures and
assist in ruling out other disorders
• Cytologic studies of the CSF
-May be performed to detect malignant
cells because CNS tumors can shed cells
into the CSF
 MEDICAL
MANAGEMENT
MEDICAL MANAGEMENT
• Chemotherapy
• Radiation Therapy
- The corner-stone of treatment of many brain tumors,
decreases the incidence of recurrence of incompletely
resected tumors
• Brachytherapy
-the surgical implantation of radiation sources to deliver
high doses at a short distance
-had promising results for primary malignancies
-it is used as an adjunct to conventional radiation therapy
or as a rescue measure for recurrent disease
• Intravenous (IV) autologous bone marrow transplant
-is used in some patients who will receive chemotherapy
or radiation therapy because it has the potential to
“rescue” the patient from the bone marrow toxicity
associated with high doses of chemotherapy and
radiation
-a fraction of the patient’s bone marrow is aspirated,
usually from the iliac crest, and stored
-the patient receives large doses of chemotherapy or
radiation therapy to destroy large number of malignant
cells
-the marrow is then reinfused intravenously after
treatment is completed
 MEDICAL MANAGEMENT
• Corticosteroids
-May be used before and after treatment
to reduce cerebral edema and promote a
smoother, more rapid recovery
• Gene-transfer therapy
-Uses retroviral vectors to carry genes to
the tumor, reprogramming the tumor
tissue for susceptibility to treatment
• Photodynamic therapy
-This is a treatment of primary malignant
brain tumors that delivers a targeted
therapy while conserving healthy brain
tissue
- Combines a drug (called a
photosensitizer or photosensitizing
agent) with a specific type of light to kill
cancer cells
 SURGICAL
MANAGEMENT
 SURGICAL MANAGEMENT
• Trans sphenoidal microsurgical removal
-Treatment for most pituitary adenomas
-Whereas the remainder of tumors that
cannot be removed completely are treated
by radiation
-An untreated brain tumor ultimately leads
to death, either from increasing ICP or from
the damage to brain tissue it causes
• Craniotomy
-Is used in patients with meningiomas,
acoustic neuromas, cystic astrocytomas of
the cerebellum, colloid cysts of the third
ventricle, congenital tumors such as
dermoid cyst, and some of the granulomas
-The rationale for resection includes
relieving ICP, removing any necrotic tissue,
and reducing the bulk of the tumor, which
theoretically leaves behind fewer cells to
become resistant to radiation or
chemotherapy
SURGICAL MANAGEMENT
• Radioisotopes
-Such as iodine 131 can also be
implanted directly into the tumor to
deliver high doses of radiation to the
tumor (brachytherapy) while
minimizing effects on surrounding
brain tissue
-The use of the gamma knife to
perform radio surgery allows deep,
inaccessible tumors to be treated,
often in a single session
-Precise localization of the tumor is
accomplished using the stereotactic
approach and by minute
measurements and precise
positioning of the patient
-Multiple narrow beams then deliver
a very high dose of radiation