INTRA CRANIAL NEOPLASM

Nurdjaman Nurimaba dr, Sp.S(K) Neurological Department Medical Faculty, Padjadjaran University

INCIDENCE
In 1983 estimated 400.000 deaths from cancer in USA Patient dying of primary tumors of the brain 12.000, but in another 70.000 to 80.000 mainly by metastases

CAUSATION
Antecedent : - Head injury - Infection - Metabolic and other systemic disease - Exposure to toxins and radiation - Genetics - Embryonic cell - Carcinogen

 Tumors rise from vestigial tissues : - Craniopharyngiomas, teratomas, lipomas and chordomas Tumors from rest of glioblast : - Gliomas Genetics disease : - Von Reckling Hausen neurofibromatosis, tuberousclerosis, hemangioblastomatosis

 Certain midline tumors of closure of neuraltube : polar spongioblastoma, retinoblastoma, gliomas of optic nerve, hypothalamus, cerebellum and spinal cord.
The factor of age : - medulloblastoma, polar spongioblastoma (piloid astrocytomas), pinealomas occur before the age of 20 years

 Meningiomas, glioblastomas, frequent around the age of 50 years Carcinogen : Hydrocarbons and nitrosamins could cause a variety of gliomas Concepts of pathogenesis of primary tumor of the CNS ; 1. Histogenic theory 2. Neoplastic transformation

Types of intracranial tumors

Tumor Gliomas : Glioblastoma multiforme Astrocytoma Ependymoma Medulloblastoma Oligedendrocytoma Meningioma Pituitary adenoma Neurinoma (Schwannoma) Metastatic carcinoma Craniopharyngioma, teratoma Angiomas Sarcomas Unclassified (mostly gliomas) Miscellaneous(pinealoma, chordoma) Percent of total 20 10 6 4 5 15 7 7 6 4 4 4 5 3

CLINICAL SYMPTOM
General evidence of increased intracranial pressure : - Headache - Nausea and vomiting - Seizure - Decrease conciousnes
Focal symptom : - Hemianopsi homonim, false localizing sign - Change in mental function , sensation - Change hormonal function

 Neoplasm intracranial can cause herniation : - Falx herniation - Trans tentorial herniation - Tonsilar herniation - Uncal herniation

Neuroepithelial tumors : Astrocytic tumors : Diffuse astrocytoma Anaplastic astrocytoma

Neuronal tumors : Ganglioblastoma Gangliocytoma Primitive neuroectodermal tumor; Glioblastoma multiforme Medulloblastoma Juvenile pilocytic Pineoblastoma astrocytoma Neuroblastoma Subependymal giant cell Meningeal tumors astrocytoma Meningioma Oligodendroglioma tumor : Papillary meningioma Oligodendroglioma Anaplastic meningioma Anaplastic oligodendroglioma Nerve sheath tumors : Ependymal tumors : Schwannoma Ependymoma (Neurilemoma) Myxopapillary Neurofibroma ependymoma Neurofibrosarcoma Anaplastic ependymoma Tumors of blood vessel origin : Subependymoma Choroid plexus tumors : Hemangioblastoma Choroid plexus papiloma Hemangiopericytoma Choroid plexus carciaoma

Germ cells tumor Germinoma Embryonal carcinoma Choriocarcinoma Teratoma Malignant lymphomas : Hodgkin's disease Non Hodgkin's L. Malformative tumors : Craniopharyngioma Epidermoid Cyst Dermoid Cyst Neuroepithelial (colloid) cyst Lipoma Regional tumors : Chordoma Glomus jugulare tumor Chondroma Metastatic tumors Carcinoma Sarcoma Lymphoma

TYPE OF THE TUMOR

Primary tumor : - 90 - 94 % from the intracranial neoplasm, can cause from parenchyma cells, meningen, vascular, hypophyse, embryonal cells, neural sheats Secondary tumors (metastatic tumors): - 5% - Lungs, bone, thyroid, mammae, cervix, prostate

TOPOGRAPHY
Supra tentorial: - Hemispheric : 1. Astrocytoma 2. Glioblastoma 3. Metastasis 4. Meningioma 5. Lymphoma - Sellar zone : 1. Pituitary adenoma 2. Craniopharyngioma 3. Meningioma 4. Optic and hypothalamic glioma

 - Pineal zone : 1. Pineocytoma 2. Pineoblastoma 3. Germinoma 4. Astrocytoma 5. Metastasis

 Infratentorial tumors : - Midline : Pediatric 1. Medulloblastoma 2. Ependymoma 3. Pontine glioma Adult 1. Pontine glioma 2. Schwannoma 3. Meningioma 4. CP papilloma 5. Metastasis

 - Cerebellar hemisphere : Pediatric 1. Juvenile Astrocytoma Adult 1. Hemangioblastoma 2. Astrocytoma 3. Metastasis 4. Medulloblastoma

 Malignant tumors : 1. Astrocytoma grade III & IV 2. Ependymoma grade I - IV 3. Oligodendroglioma 4. Medulloblastoma 5. Neuroastrocytoma Benign tumors : 1. Meningioma 2. Craniopharyngioma 3. Neurolemoma

 Foster-Kennedy Syndrome - Fronto basal tumor symptom : 1. Papil atrophy ipsilateral 2. Anosmia ipsilateral 3. Papil oedema contralateral

LABORATORY EXAMINATION
Scheedel photo : - Erosion of posterios dorsum sella - Ballooning sella - Impression digitate
Angiography

CT Scan
MRI

TREATMENT
Medicamentous : - Corticosteroid - Mannitol - Anticonvulsan Operative Radiation : - Curative : Medulloblastoma - Decrease of exacerbation: Astrocytoma, oligodendroglioma, ependymoma, chordoma, metastasis

Chemotherapeutica

PROGNOSIS
Malignant tumors : Non Satisfied Benign tumors : Good

HATUR NUHUN