Mohammed Abdulridha - Study with me

Dr.Sarah AL.Abedy
M.B.Ch.B - F.I.C.M (neurosurgery)
objectives
1. Defination of space occupying lesion.
2. Classify the brain tumors
3. Describe main clinical features
4. Know how the tumor is diagnosed
5. Discriminate the radiological findings of
main tumor types
6. Know the lines of treatment
7. Know which is the common tumor type
CAUSES
1- congenital(colloid cyst)
2- infection & infestation abscess , H. cyst
3- trauma
4- tumors
5- vascular
is an abnormal mass of tissue in which
cells grow and multiply uncontrollably,
unchecked by the mechanisms that
control normal cells.
uncontrolled cell division ‫ ھﻮ‬tumor‫ واﻟـ‬tumor ‫ ﻣﻤﻜِﻦ ﯾﺴﺘﮭﺪف ﺑﻮاﺳﻄﺔ‬organ ‫ ﺣﺎﻟﮫ ﺣﺎل أي‬brain ‫أﻟـ‬
More than 150 different brain
tumors

two main groups:

1-primary brain‫ ﺑﺎﻟـ‬origin ‫ﯾﻌﻨﻲ اﻟـ‬

2-scondary (metastatic) Most common brain tumor

lung‫وﺧﺼﻮﺻًﺎ اﻟﻠﻲ ﻣﻦ اﻟـ‬
 glial cell ‫ واﻟـ‬neurons and glial cell ‫ ﯾﺘﻜﻮﱠ ن ﻣﻦ‬brain‫اﻟـ‬
:‫ ھﻲ‬type 4 ‫ﺗﻘﺴﱠﻢ إﻟـﻰ‬
1.Astrocyte
2.oligodendrocyte:
myelin sheath ‫ھﻲ اﻟﻠﻲ ﺗﺴﻮي اﻟـ‬
3.epindymal cells
4.microcyte
‫ ﻣﺎﻟﺘـﮭﺎ‬cellular origin‫ ﺣﺴـﺐ اﻟـ‬classification of tumor‫ﻓﺎﻟـ‬
 Type of cells:
1-astrocytic tumors: astrocytoma
2-oligodendroglial tumors: oligodendroglioma
3-mixed: oligoastrocytoma
4-choroid plexus : c.p.papilloma
5-neuronal: gangliocytoma
6-pineal: pinealocytoma
8-meninges: meningiomas
9-germ cell: germinoma
10-sellar region tumor: craniopharyngio
,lobe can be involved ‫ وأي‬most common intracranial tumor‫ ھﻮ اﻟـ‬glioma ‫أﻟـ‬
11-lymphomas epilepsy and ‫ وﻣُﻤﻜﻦ‬space occupying lesion ‫ ﻣﺎﻟﺘﮭﺎ ھﻲ‬presentation‫اﻟـ‬
,neurological deficit
‫ اﻟـ‬grade4 ‫ إﻟـﻰ‬grade 1 ‫ ﻣﻦ‬grading ‫ وﯾﺼﯿﺮ‬histopathology‫راح ﯾﺼﻨﻔﻮھﺎ ﺣﺴﺐ اﻟـ‬
12-mesenchymal: lipoma ‫ ھﺬا‬gradeglioblastoma
3 and grade4 ‫ ﺑﯿﻨﻤــﺎ‬benign behaviour ‫ ﻋﺎدةً ﺗﻜﻮن‬grade 1 and grade2
‫ ﻋﻨﺪھﺎ ﺗﺴﻤﯿﺔ ﺧﺎﺻﱠـﺔ ﺑﯿﮭﺎ ھﻲ‬grade 4‫ اﻟـ‬malignant behaviour
13-ependymal tumor: ependymoma multiforme
1-Astrocytoma
 2-Ependymoma 5-4% of intracranial tumor

Aries from the ependymal lining of ventricular system either

supratentorial(third and lateral ventricle) or infratentorial
(fourth ventricle and central canal of spinal cord).
 3-Oligodendroglioma

The most common location => frontal and temporal lobe.

The most common presentation => epilepsy.

calcification or ca deposit ‫ ﻣﻨﮭﺎ ﺑﯿﮭﺎ‬90%

Most common age => third decade of life.

4-Meningioma
Distribution of Meningioma?
intracranial cavity ‫ إﻟﮭﺎ ﻣﻤﻜﻦ ﺗﺴﺘﮭﺪف اﻟـ‬different location ‫ﻋﻨﺪﻧﺎ‬
parasagittal convexity‫و‬
Supra cilliary region
cerebellopontine angle
Olfactory base

Most common age => third-fourth decades of life.

,intracranial tumor ‫ ﻣﻦ‬%15 ‫ﺗﺸﻜﱢـﻞ ﺣﻮاﻟﻲ‬
Aries from meningothelial lining of arachnoid mater,
Female predominant,
etiology=> idiopathic
enhancement during pregnancy ‫راح ﯾﺼﯿﺮ ﻟﮭﺎ‬Meningioma ‫ ﺷﺎﻓﻮا أﻧﮫ ھﺬه اﻟـ‬theory ‫وﻟﻜﻦ ھﻨﺎك ﺑﻌﺾ اﻟـ‬
FALX & SPHENIOD & OLFACTORY GROOVE
Site & size
Signs & symptoms according to location of pathological lesion
FUNCTIONAL AREAS OF BRAIN
 tumor ‫ ﯾﻌﻨﻲ إذا‬signs and symptoms according to the location of pathology ‫ راح ﯾﺴﻮي‬tumor‫أﻟـ‬
, contralateral weakness‫ راح ﯾﺼﯿﺮ‬precentral gyrus ‫ أو‬motor cortex ‫ﻣﻮﺟﻮد ﺑﺎﻟـ‬
. contralateral sensory loss or disturbance ‫راح ﯾﺼﯿﺮ‬postcentral gyrus‫ ﻣﻮﺟﻮد ﺑﺎﻟـ‬tumor‫أو إذا اﻟـ‬

Frontal lobe =contralateral weakness, motor

aphasia(dominant)

Parietal lobe=contralateral sensory loss,

sensory aphasia(dominant)

Temporal lobe=epilepsy, memory disturbance

Occipital lobe=visual field defect

Patient with SOL presented with signs &
symptoms of increase ICP

1-headache. Early morning headache

2-nuasea & vomiting. Projectile vomiting

Funduscopic examination ‫ﻧﺸﻮﻓﮭﺎ ﺑﺎﻟـ‬
3-blured vision & papilloedema
4-disturb level of consciousness.
5-epilepsy
‫ راح‬CO2 tension‫وﺑﺎﻟﺘﱠــﺎﻟﻲ اﻟـ‬respiratory Rate‫ﺑﺎﻟـ‬decrement ‫ راح ﯾﺼﯿﺮ‬during sleep ‫ ﻷﻧﱠـﮫ‬early morning‫ ﻋﺎدة ﯾﺼﯿﺮ ﺑﺎﻟـ‬headache‫أﻟـ‬
more volume of blood ‫ ﯾﻌﻨﻲ‬vasodilation of vascular tree of intracranial cavity ‫ ﻓﺮاح ﯾﺼﯿﺮ‬potent vasodilator ‫ ھﻮ‬Co2‫ﯾﺰداد واﻟـ‬
‫ راح‬intracranial cavity‫ ﺑﺎﻟـ‬more volume of blood ‫ ﻣﺎﻟﺘﮫ ﻋﺎﻟﻲ وﺻﺎر ﻋﻨﺪه‬ICP‫ واﻟـ‬tumor ‫ وھﻮ أﺻﻼً ﻋﻨﺪه‬inside the cranial cavity
‫ ﻓﺮاح ﯾﺼﯿﺮ‬area postrema‫ وﺗﺤﺪﯾﺪًا ﺑﺎﻟـ‬Pons ‫ اﻟﻤﻮﺟﻮد ﺑﺎل‬stimulation of vomiting centre ‫ ﻓﯿﺼﯿﺮ‬ICP‫ إﺿـﺎﻓﯿﱠـﺔ ﺑﺎﻟــ‬increment ‫ﯾﺼﯿﺮ‬
‫وھﺬه اﻟـ‬tachypnea ‫ راح ﺗﺼﯿﺮ‬during vomiting ‫ ﻷﻧﱠـﮫ‬headache ‫ ﻣﺎﻟﺖ‬severity‫ وﺗﻘﻞ اﻟـ‬reflex of vomiting in early morning
‫ ﻟﮭﺬا‬volume of blood‫ وﯾﻘﻞ اﻟـ‬vascular tree of the brain ‫ ﺑﺎﻟـ‬vasoconstriction ‫ راح ﯾﻘﻞ وﯾﺼﯿﺮ‬Co2‫ ﻓﺎﻟـ‬Co2‫ ﻟـ‬wash ‫ ﺗﺴﻮي‬tachypnea
.temporarily relief of headache ‫راح ﯾﺤﺲ‬
‫ھﺬا اﻟﺴّﻼﯾﺪ ﻣﻦ اﻟﻤُﺤﺎﺿﺮة اﻟﻤُﺤﺪﱠﺛﺔ‬
 space occupying lesion <= ‫ﯾﺠﻲ اﻟﻤﺮﯾﺾ ﯾﻘﻮل ﻋﻨﺪي ﺻﺪاع وأﻗﻌﺪ اﻟﺼّﺒﺢ أﺗﻘﯿﱠﺄ ارﺗﺎح‬
sinusitis<= ‫أو واﺣﺪ ﯾﻘﻮل ﻋﻨﺪي ﺻﺪاع وﻣﺎ أﻛﺪر أﻧﺎم وﺧﺸﻤﻲ ﻣﺴﺪود وأﺗﻨﻔﺲ ﻣﻦ ﺣﻠﻜﻲ وﻣﻦ أدﻧﻚ ﻋﯿﻮﻧﻲ ﺗﺮﯾﺪ ﺗﻮﻛﻊ ﺑﺎﻟﻜﺎع ﻣﻦ اﻟﻮَﺟﻊ‬

-history
-clinical examination
-investigations
Oligodendroglioma ‫ ﻣﺜﻞ‬tumor‫ ﺑﺎﻟـ‬Calcification ‫اذا ﻋﻨﺪي‬X ray ‫ﻣﻤﻜﻦ ﺗﻔﯿﺪﻧﺎ أﻟــ‬
signs of ‫ ﺑﺎﻟـ ﻋﻈﻢ وﻣﻤﻜﻦ أﺷﻮف‬Hyperostosis ‫راح ﯾﺴﻮي‬Meningioma ‫أو ﻋﻨﺪي‬
: ‫ اﻟﻠﻲ ھﻲ‬skull x ray‫ ﺑﺎﻟـ‬increase ICP
-ballooning of sella turcic
1-X-ray -erosion of anterior and posterior
Clinoid process
-Diasthesis of sutures
2-brain CT-scan -Copper beaten appearance
‫ راح ﯾﺼﯿﺮ ﺑﯿﮭﺎ رﺻﻌﺎت ﻣﺜﻞ‬skull ‫ ﻣﻌﻨﺎه أنﱠ اﻟـ‬Copper beaten appearance ‫أﻟـ‬

3-brain MRI ‫اﻟﺮﱠﺻﻌﺎت اﻟﻤﻮﺟﻮدة داﺧﻞ ﺟِﺪر اﻟﻨﱡﺤﺎس‬

4-angiography

Copper beaten appearance

 . curative ‫ ﯾﻌﻨﻲ ﻣﻮ‬temporarily ‫ ﯾﻜﻮن‬medical treatment‫أﻟـ‬

1-medical The aim of medical treatment to reduce signs and symptoms of ICP(role of H):
Head elevation
Hypothermia
Hyperventilation
Hypertonic fluid like mannitol

2-surgical
Just biopsy or debulking or subtotal removal or total removal ,
:ٰ‫وھﺬه اﻻﺳﺘﺮاﺗﯿﺠﯿﺎت ﺗﻌﺘﻤﺪ ﻋﻠﻰ‬
Size and location of the tumor
Accecepility

tumor below 2cm‫ راح ﯾﻜﻮن اﺣﺘﻤﺎل اﻟﺨﻄﺄ ﻛﻠﺶ ﻋﺎﻟﻲ ﺧﺼﻮﺻًﺎ إذا اﻟـ‬biopsy ‫اذا ﻧﺮﯾﺪ ﻧﺄﺧﺬ‬

safe ‫أﻛــﻮ ﺷﻲء اﺳﻤَ ﮫ‬tumor‫ ﻷﻧﱠﮫ ﺑﺎﻟـ‬Complementary treatment ‫ ھﻮ‬radiotherapy ‫اﻟـ‬

3-radiotherapy ‫ ﺑﺤﺪود ﻣﻦ‬normal surrounded tissue‫ راح ﺗﺄﺧﺬ ﻣﻦ اﻟـ‬tumor ‫ اﻟﻠﻲ ھﻮ أﻧﮫ ﻣﻦ ﺗﺸﻮف‬margin
‫ وآﻧﻲ أﺟﻲ‬5cm ‫ ھﻮ‬tumor ‫ ﻣﺎ ﺗﻘﺪر ﺗﺴﻮﯾﮭﺎ ﻷﻧﮫ اﻟـ‬brain ‫ ﺑﺎﻟـ‬safe margin‫ وھﺬه اﻟـ‬cm 3-5
!‫؟‬hemisphere‫ ﻓﺸﻜﺪ راح ﯾﺒﻘﻰ ﻣﻦ اﻟـ‬3cm‫ ﺗﻘﺮﯾﺒﺎ‬safe margin‫آﺧﺬ‬
gross ‫ راح أﺷﯿﻞ اﻟـ‬tumor‫ ﻟﺬﻟﻚ ﻣﻦ أﺷﯿﻞ اﻟـ‬not practical ‫ ھﺬا‬brain‫ ﻣﻦ ال‬safe margin ‫ﻓﺄﺧﺬ‬
, tumor
Microinfiltration of the malignancy to the normal tissue cells ‫ﻛﺬﻟﻚ ﯾﺼﯿﺮ‬
‫ وﺣﺘﱠـﻰ ﺑﺎﻟـ‬Microinfiltration ‫ ﻋﻠﻤﻮد ال‬radiotherapy‫ أرﺳﻞ اﻟﻤﺮﯾﺾ ﻟﻞ‬surgery ‫ﻟﺬﻟﻚ ﺑﻌﺪ‬
radiotherapy ‫ ﻣﺮﱠات أﺳﺘﺨﺪِ م‬benign lesion

4-chemotherapy
5- Gamma knife
Cerebral metastasis are the most
brain tumor.

more than 50% of brain tumors

Most common in elderly
Source of metastasis
1-lung CA Male smoker
2-breast CA
3-kidney tumor
4-GIT tumor
5-melanoma
6-undetermined 10%
Clinical features:

Diagnosis: same

Treatment:
‫ اﻟﻠﻲ ھﻲ‬primary‫ ﻣﺎﻟﺖ اﻟـ‬treatment ‫ﻧﻔﺲ اﻟـ‬
1-medical=> palliative
2-surgical=>undetermined primary source of tumor
removal ‫ ﻣﻤﻜﻦ أﺳﻮي ﻟﮭﺎ‬large solitary mass ‫ أو اذا ﻋﻨﺪي‬tumor‫ ﻣﺎﻟﺖ اﻟـ‬source‫ ﺣﺘﻰ أﻋﺮف اﻟـ‬biopsy ‫أﺳﻮي‬
3-radiotherapy
4-chemotherapy
HomeWork
How papillodema happened when there is
raised ICP?
 :‫ﻋَـﻤﱠـﺎر‬.‫أﺳﺌِـﻠﺔ ﺟﺎﯾﺒﮭﺎ د‬
1-primary sites of metastasis of brain tumor ‫ﺑﺎﻟﺘﺮﺗﯿﺐ‬
2- clinical features of brain tumor
3-etiology of neural tube defects