BraintumorWhatisbraintumor?IntracranialtumorCraniocerebraltumorBraintumorsarethe:leadingcauseofcancer-relateddeathsinmalesages20-39.

fifthleadingcauseofcancer-relateddeathsinwomenages20-39.TeachingGoalContenttomaster:1.Commonclinicalcharateristicsofcerebraltumor;2.DiagnosisandtherapeuticprincipleContenttobefamiliarwith:1.Classificationofcerebraltumor;2.Mainclinicalmanifestationsofvariousbraintumors3.EtiologyandepidemiologyClassificationofcraniocerebraltumors1.Scalptumors(less,angioma,melanama,neurofibroma,basaloma)2.Skulltumors(less,osteoma,multiplemyeloma,fibrosarcoma,dermoidandepidermoid)braintissuemeningesprimarycranialnerve

3.Intracranialtumors

intracranialvessel

embryonictissue

Metastaticfromotherorgans

Primarybraintumors1.Neuroepithelialtumors(gliomas)(神經(jīng)上皮腫瘤、膠質(zhì)瘤)

Astrocytomas（星形細(xì)胞瘤）

Oligodendroglioma（少突膠質(zhì)細(xì)胞瘤）

Medulloblastoma（髓母細(xì)胞瘤）

Ependymoma（室管膜瘤）2.Meningioma（腦膜瘤）3.Neurofibroma（神經(jīng)纖維瘤）3.Primarycerebrallymphoma

（原發(fā)性腦淋巴瘤）4.Pituitaryadenoma

（垂體腺瘤）5.Tumorsofothertissues

Bloodvessels:haemangioblastoma（血管母細(xì)胞瘤）

Germcells:germinoma（生殖細(xì)胞瘤teratoma（畸胎瘤）.

Tumoursofmaldevelopmentalorigin:Craniopharyngioma（顱咽管瘤）,epidermoid（表皮樣囊腫）/dermoidcyst（皮樣囊腫）Epidemiology1.Annualincidence:about8.2per1000002.Accountingforabout5%ofallneoplasmsinthebody3.Makeupapproximately50%ofallchildhoodmalignancies.4.DifferentprimarytumortypesandtheiranatomicallocationvarieswithageAdults:

gliomas,meningiomas.80-85%supratentorialcompartment.15-20%infratentorialcompartment.Children:

medulloblastomas,cerebellarastrocytomas40%supratentorialcompartment.60%infratentorialcompartment.5.Incidencedistributionofprimarybraintumors

6.IncidenceofdistributionofallgliomasbyhistologysubtypeEtiologyWhatfactorscancausebraintumors?1.Geneticfactors2.Physicalfactors3.Chemicalfactors4.Biologicalfactorsclinicalmanifestationsdependonthesiteofthetumorsandthespeedofgrowth1.Featuresofincreasedintracranialpressure1）headache2)Vomiting3)Papilloedema2.Focalsymptomsandsignsdependsontheanatomicalsitewhetherthetumoreffectisirritativeordestructive.1)Benign:slowgrowing,mildedema2)Malignant:fastgrowing,aggressive,severveedema3.clinicalmanifestationsoflesionsinthecerebralhemisphere

EpilepsyMentalsymptomsMotordisorderSensorydisturbanceAphasiaVisualfielddefectsEpilepsypartialseizuressimplepartialseizurecomplexpartialseizuregeneralizedseizureParalysisMusclestrengthgradingscale0/5Nocontraction1/5Visible/palpablemusclecontractionbutnomovement2/5Movementwithgravityeliminated3/5Movementagainstgravityonly4/5Movementagainstgravitywithsomeresistance5/5Movementagainstgravitywithfullresistance(normal)Aphasiaagraphia

motoraphasiaBroca’sareaWernicke’sarea

alexiasensoryaphasia4.Clinicalmanifestationsoflesionsinthesellarregion

DecreasedvisionVisualfielddefectsEndocrinologicalsymptomshypopituitarismHyperprolactinemiaAcromegaly/gigantismCushing,ssyndromeThyrotoxicosis5.ClinicalmanifestationsoflesionsinthepinealbodyObstructivehydrocephalusVerticalgazeparalysisParinaudsyndromepinealbodyprecociouspuberty(性早熟)

Dysfuncitonofmidbrain,cerebellumandhypothalamus6.ClinicalmanifestationsoflesionsintheposteriorcranialfossaCerebellarhemisphere:ataxiaintheipsilaterallimbCerebellarvermis:equilibriumdisorderCerebellopontineanglearea:damagetheipsilateralcranialnerveV-Ⅷandcerebellarhemisphere.Clinicalcharacteristicsofdifferenttypesofintracranialtumors1.Astrocytomas(星形細(xì)胞瘤)

thecommonestprimarybraintumors.occuratanyage,thecommonestintheagesof40-60years.Male/femaleincidenceis2:1.occurwithequalincidencethroughoutthefrontal,temporalandparietallobes,butareuncommonintheoccipitalFourpathologicalgrades(KernohanI-IV):gradesIandII：Low-gradeastrocytoma.commonlyseeninchildren/youngadults.gradeIII:Anaplasticastrocytoma.gradeIV:GlioblastomamultiformisMalignantastrocytomasarefarmorecommonthanbenignones.pilocyticastrocytoma(gradeI)F,14-year-oldpreoperationpostoperationpreoperationpostoperationastrocytoma(gradeII)F,40-year-oldPreoperationPostoperationBrainstemastrocytoma(WHOIII)

10-year-oldboypreoperationpostoperationGlioblastomamultiformis(gradeIV)

M,50-year-old2.Oligodendrogliomaslow-growing/lowmalignancy.youngerage-group(30-50years).commoninfrontallobe.Imagingrevealsawell-demarcatedtumor,frequentlywithareasofcalcification.（少突膠質(zhì)細(xì)胞瘤）3.Medulloblastoma（髓母細(xì)胞瘤）themostcommonmalignanttumorofchildhood(4-8years).arisesfromembryonictissueinthecerebellarvermis.mayseedthroughtheCSFpathwaystootherpartsofthecraniumorthespinalcord.4.Ependymoma（室管膜瘤）thesecondmostcommontumorofchildhood.occursintheventricularsystemorthespinalcanal;commoninthefourthventricleandinthecaudalpartofthespinalcord.

EpendymomaInlateralventricleInfourthventricleInmedullarycone5.Meningioma(腦膜瘤)AbenigntumorarisingfromthearachnoidCompressesratherthaninvadestheneuraltissues.Maximumincidenceoccursin40-60yearsofageImagingrevealsawellcircumscribedlesionwithoccasionalcalcification.Commonin:sylvianregion,parasagittalsurfaceolfactorygrooves,lesserwingsofthesphenoid,tuberculumsellae,cerebellopontineangle,thoracicspinalcord6.Neurofibroma(神經(jīng)纖維瘤)abenign,slow-growingtumor.developsonthevestibulardivisionofcranialnerveVIIIcommonly(misleadinglycalledanacousticneuroma).sensorineuraldeafnesstinnitusandvertigo.Itmayappearaspartoftheneurofibromatosissyndrome(type2),whenothertumours(particularlycontralateralacousticneuromas)shouldbesought.neurofibromatosissyndrome7.Primarycerebrallymphomaaggressivetumoursaccountforupto10%ofcentralnervoussystemcomplicationsinAIDSpatients.oftenperiventricular,andmaybemultiple.8.Pituitaryadenoma（垂體腺瘤）abenigntumorpresentswithneurologicalorendocrinologicalsymptomsSomesmallertumorspresentwithhyperprolactinemiaoracromegaly/gigantism,Cushing,ssyndromeorthyrotoxicosis

Largepituitaryadenomausuallypresentswithheadache,bitemporalhemianopia(fromupwardpressureontheopticchiasm),andoccasionallyhypopituitarism.？CongenitalbenigntumorStemfromcranialpharynxtuberesidualtissueinthepituitarystalkinembryonicperiodCommoninchildhoodMostlycysticManypostoperativecomplications9.Craniopharyngioma（顱咽管瘤）10.Haemangioblastoma（血管母細(xì)胞瘤）BenigntumorLocatedinthecerebellarhemisphereHaveageneticpredispositionMostlycysticwitharichbloodsupplyofnodules11.Germcelltumor（生殖細(xì)胞腫瘤）Avarietyofpathological

type:germinoma,teratoma,endodermalsinustumor,embryonalcarnioma,chorionicepithelioma,mixedgermcelltumorCommonlyLocatedinpinealregionandsellarregion70%haveoccurredinages10-24SpreadeasilywithCSFSensitivetochemotherapyandradiotherapy12.Metastaticbraintumors（腦轉(zhuǎn)移瘤）Metastaticbraintumoursarearound8timescommonerthanprimaryones.About20%ofpatientsdyingwithothertumorswillhaveintracranialmetastases.Theprimarytumorsare:44%bronchus10%breast7%genitourinary.6%bowel3%skin(melanoma)30%others.DiagnosisLocalizationdiagnosisQualitativediagnosis1.Clinicaldiagnosis:intracranialhypertension,seizure2.Imagediagnosis:CT,MRI,DSA,PET,SPECT3.Electrophysiological

examination:EEG,

cerebralevokedpotential4.laboratoryexamination:

anteriorpituitaryhormone,HCG,AFPnormalglioma

1.magneticresonancespectroscopy(MRS)2.functional

magnetic

resonance

imaging(fMRI)

Showrelationshipbetweentumorandimportantareaofbrain3.magneticresonancediffusiontensorimaging(DTI)Shows

the

relationshipbetween

tumors

and

the

vitalnerve

fiber

bundle

directlyTreatment1.Symptomatictherapydehydrationmedicine

,steroids(toreducecerebraledema),anticonvulsants.2.Benigntumor:Surgery3.Malignanttumor:multimodaltreatment(surgery+radiotherapy+chemotherapy)Routinecraniotomy常規(guī)開顱術(shù)Routinecraniotomy常規(guī)開顱術(shù)external

ventricular

drainageventriculo-peritonealshuntoperationAdvancedtechniqueMicroneurosurgeryEndoscopictechniqueEndoscopicresectionofpituitaryadenomaEndoscopicthirdventriculostomyNeuralnavigationneurosurgeryIntraoperativeawakenandcorticalelectricalstimulationtechnology

Thepatientremainsawakeduringoperationandacceptsthecortexstimulation,whichiseasilyforneurosurgontojudgethefunctionalregionofbrain.Thetechnologycanreducethedamageofbrainfunctionasmuchaspossible.Intra-operativeMRI

Intraoperativeneurophysiologicalmonitoring

Radiotherapy1.Highlysensitivetoradiotherapy

medulloblastoma,germinoma,lymphoma2.Maglinantglioma1)Stronglyrecommendregularfractionatedirradiationasthestandardtherapyforpostoperativeglioma2)Xorrknifeisnotrecommendedthepreferredtreatmentforglioma3)Recommendstartingradiationtherapyas