Intra Cranial lumours tolo2|202

lurnou Mostly, wlhen nomal cells qrow old os

get damago
thu die and veplaced by new cells.
Sometimes, this pocess qpes Wonq. New cells fom hen
body doesn't need them and old or damaged cells dont die a
they should This buldup of exba cells otttn foms a mass of
tssue called qrowth of tumou
rain Tumour It s a collection ov mass of abnomal cells tn Bratn

Skuill, ihich encloses the braín is

Veny igid.Any grouth inslde
this vestmctd place increases intra csanial pnsurt, hich Con Cause

brain damage may be even life thtatntng.

Aetology
| InacHvation of expitession of tumouy SupressoT genes
Eq-Low qrade astoyoma
2Ovex enpresslon of genes Controlltnq qrowth tactor
Egr Pimavy gkoblastonma.
3. Inhevitd factors (mino role : 5)
Couwden's disease, Li- fraumeni sundome
EVon Hippel-Lindau disease,
tinea capitis & childhood
4 Cranial mradiation: For trtatment ot
both benign 6 malignan
eukemia shows an inctased incidence of

Eq Asbroytoma, Meningloma
of ymphoma.
5.JmmunoSupptssion: Inctased încidence
1Inudence
Aduls children
Clioblastoma :15 Medulloblas toma/PNET :16
|Low grade qlioma: 5% Low qrade glioma 33

Meningiorma S Makgnant gliona 14

Pteultay edenoma; 3a5. Ependymoma :10
CYanlophayngioma 6
Pimamy CNS lymphoma: Ht
Pextpheral Neve sheath Gem cel tumours 5
tumour Cschwannoma)8 o Mentngioma 51
Others :8 Others 16.
>Pimany brain tumours dCcur in 6/1 akh pex yeav appoumalely
About in 13 Occur tn children under s years.
8 5 . ot patienG Nith a maliqnany have a CNS metastasts.

Pevcentage of childhood tumouY: 1 Frontal, pictal,occipital

6 Cevebellum
m . Brain slem ok
ftoish buda 1un 2l bluo
classihcation r U 10 grp ollnd
H O publlshed a untversal classiftcation system for CNS tumours,tn.
49. Accorcling to thel micoScoplc charackristiCs, Tumours leve
ctassified intp 2Cattgoess dol23007/ 3 l hbrsier
.Pimary Brain TumourS Odainate in he Ns 3pnib ior
These tumouns Can be Benlgn ov Malionant.
1Ppojoi1s/A
Benian Brain tumours o Malignant brain tumours
Do not Contain Cancer Cells. ) Contatn Cancer cells.
t) Can be removed & vatly grouw backill, ) More sevious ofkn threat tolt
iHave an obvious border / edge i) Rapid epouwth
Donot Sprtad to other pavs of body May spead to o ther pars, of
Donot învade tesues aound themuol bratn or to spinal cord but
v)
vOn sensttve arta ot
bain cause
can cause rarcly spvtad to other pavs of
ebody. noibniharvi lain0)
Sexious health problems lileiobion
thrcatenin )Invade neavby healthy bratn
can beconme maliqnant hssue
vi ith time, 9bon h20r0nlro2239qoe aum
& Secondary Brain TumourY
Metastattc brain tumous 0rtainale trom malignancies outside the
CNS & Sprtad. to brain through arttrial ctreulation
Amlnloolbs69 roonldois
. Site ol incidence om Aduls oscl Children

Suprcekentoial8085n Ho
2 moipririslM
Infratentoial o15a013 60

Average uviva Mith hebtatment is 6 months opproximately

the eAent o other Systemtc metastases.
but Vanes wldely by
rioip sM
Lungs > Breast> SKin > G1 bract > kidnay
 Tumour Grrade-By the way Cells look under a micoscope

Cracde 1: The ssue is bentgn

Cellt appeay nearly tke nomal bratn cells

o
slouwly
Grade T h e tissue 1s malignant
Cells appear less ikely as nomal cetls
that look very diFfevent
Grade l Maliqnant tissue has cetls
foom nomal cells.
gvowing Cana plas
H)
Actively abnoma
tHssue has cells that
look most
Grade Y i
Maltgnant
Grrou qukkly
on i s u e
of oiqin in a000
based
NHO agreed ctassification
Pathological classifhcatlon
Neuroepithelial: common pimay
brain tumou
Asroutoma-The most
4 Astrdytes:
Depending on the deqee of malignancy
ashoytomas, pilocytic
tyPe
Crrade 1-low grade
protoplasmic
erade II -Diffuse types, fibrillay,
9emistocutic
Grade -

Anaplastic astry tomas

occuTS most frequently
Eprade V -
elioblastoma
sumounding9
Widely in flbrates
tissue Cmost maliqnant)

GD oligodendrocy tts: Oliqodendroglioma A slouly gowing, shasply

deHned tumour. Mined bliqoastro cy toma Grade
Naiants incude anaplastic fosm - erade Ti

the
cels Ependumoma OccuYs anyihere
thoughout
y&pencymal &,. Canal
Chooid ple uus Nentaicular System os
Spinal
CHth Venticle, Cauda equina)
Grade -[ inAllsal s Sumounding tSsue s may

Sprcad thvoughout cSF pathuways.

Rave, untommon Eprade :Aaplastic type
Cause of Hydroaphel Ersade 1: Subependymal astrpeyles Subependumomn
Benngn, Ocastonallchoold plexus papilloma-Due o excessive csF production
 (Neurons: Ganglioglioma Rave tumours Containing ganglion Cells
Ganglioytorna & abnomal neunons
ocung n Vaning
Neurocytoma degrtes of maliqnancy
Tnctudes Neny lou grade dysembmyoplastte neuroepittelhal
tumour (DENT)

Pineal cells:Pineocytoma/ Extaemely rare tumours.

Pineo blas toma less well dif ferentated show move
malignant features.
Fmbuonal cell Ovigin: Parmikive Neuwectodermal Tumours CPNET)
Small cell malignant turmours of chil3hood
Dccuing vaicy 9uprattntovially but far more
in aten o
rally-> Medullo blas tomas.
Aise in Cevebetlar Vemis.
Small closely packed cells ave oflen
aranged in
osettes Sumounding abovtive aNDNS
May Seed trough CSF pathuways.
2 Meninges
()Mentngioma: Aises tom avachnoid qranulations, closely velated to
Venous Sruses, also found over hemis phenc Convexiky
Compress athex than invade adjacent brain.
skullbase, Spinal canal & oxbit
Occur
Most are benign (tnsptte of then dendeny to ínvade adjacent bone)
but Some underqo Sacoma tous charge.
(63)Meningeal Savtoma :Eceedtnqly ravt tumours.
Pimay Meningeal melanoma
3. Neave sheath Cells
()Schwannoma: A pon Invasive, slouly qrowing ot Schwann
tumous
Cneuilernmoma/ cells, Sumounding Cranial hev ioos (Vestibular parto
neusinoma) 8h nenvt
reipheral nerves
Occurs 1n nuoftbomatosis type 2. (NF2)
Different histslogica +ypes exist : Antont tupe A, Antont type
tike
) Neumfibroma.: Tumour of Schwann Cells, ftbroblasts &petneural
cetls poducing a tustfomo enpanglon though Nhich neve kbts un
I t tnvolves spnal nerve mos /peipheral nves but arely tteas
 Cranial newes & has a
grtatr tendency to
undexgo malignant chan
than schwarno ma.
Predominant tn nuo fibromatosis type 1 CNF) although schwannoma
and miwed tumours
may also occu
HHaemangiobastpmaOccurs Nithin the Cercbellar parenchyma
CBlood Vessels) Sptnal covd
cercbellax and/or
Disease A Syndrome elatnq
VonHippel- Lindau
stic

in Ttina. G ys
blastomas With Similar tumours
pinal haemangio
lesions in pancreas & Kidney
5 em Cells to
cell tumour Compara ble
0) Eeminoma: Primitive spheoidal
Seminoma of testis.
differtntialed
tumous Containtng a miahuTe of Nell-
G1)leratoma: A
ttssues - Devmis, muscle, bone
Ce lS)
rtqiorn not avising
tvom pineal
Cuncommon tumouTS O pinead

6.umouS O Sellar Reqlon Temnanis of

cyss: Arises from embmyonic
Ci)Epidermoid/Dermoid pituitary
to stalk. A nodular

Rathke's cleft les In close relation choles leato-

grtenish fluid g
tumour With Cyste avtas containing
matous matkrial
excessive quantities
adenoma : Benign tumour, Secreting
U) Pituitay hormone,
of polactin, growth homone, adrenoOCoTtiCobrophic
thyobophin/ gonadotropin
hons-
4ysS& tumour like Condt
es[s
tumouS ansing from cell
) Epidemoid Rare custe
Deymoid asts Predebtrminated to form epidermis /dermis.

61) Cellois Cyst A Cyste tumour ansing from an embnjological

Tmnant in the anttrior oo of 3e ventrcle.
tumours
s. Local exension om adjacent cell veste of notochotd. Ma
Chovdoma: Kare
tumouT arising Arom
0) to Coccyx b u b Commonest in the
occUY any Where om Sphenoid
invading destbroyjing bone
bast-Occipltal & SacroCoccygeal megion
at these stes
 qlo mus
(t) Gtomus jugulare tumour-Vaceulair tumour aising from glómus
gugulare assueluing etther tn the bulb of inltmal jugular vein or In
mutosa D middle ear.
extend into posteior
The tumouY Invades the petrous bone &may 2
ms
fossa or neck

o) Chondoma, chondaosavcoma & Gylindomo yoel

ymphoma CPCNSL
imay Central Nenous Systm
blood Nessels, Solitarymulhfaal
toms avounc peiventicular paranchymal
patients. E ALDS
Eeneraly occuTs in imnuno- Compromised
Metastaic sptad fsom Systemic lymphoma g non- Hodgkin's lymphoma
s less common, involves mentnqes &Tarely intraparenchymal.
Mitastatuc tumourSMay avise from any primany site but most
Commonly sprtad trom brorehus brast
Nevrous System metastases occur in 25 o patienis iHh disseminab
Cancer fYt 2 0
Tumour makers-Immunohistochemical techniques pemit ldenth hcation
aid he
of anigens SpetifiC for Cevtaln cell or tissue Cháracistics &
histological diagnast of tumours.
Eghal ftbrillany aidic protin CGFAP)- for astocyte tumours.
Cytokeratin For netstaticCavcinoma
Synaptophysin-fornuronal tumours n
23faop vi) 2p0iDn
HMB HSFor maliqnant melanoma.
Ki-67 Indicate the deqie of prohkration in Navous tumouts
eGRF dentfication may help dsbngutsh bebhwen, a pimay

fom Secondany gkoblastoma

p, 19P: used toidentify loss o hetpzygostty tn olgodendvoglicra
 Classthcation accordtng to site
. Certbral Hemispherts
() Enbinste: Mentnqioma (t) Tntinsic: Asbroytoma
Glioblastoma
Cysts CDemoid, Oligodendrogliomna
Epidemoid,
arachnoid) anglhoglioma
Lymphoma
Metastasis.

2. Posterior Fossa
c) Tntinsic : Metastasis
C)Extinsic : Schwannoma Yal, V)
Haemangíoblastoma
Meningioma
Epldemoid/Dermoid ayst Medulloblastoma
avachnoid cyst Cecbellum Asboajtoma
Metastasis Brainskm

3VentricularSystem 5. Hypothalamus

collotd cyst Astouytoma

chovpid pleus papilloma
Ependymoma
Geminoma
Teratoma Ptneal
Meningioma Tegion
4. Ptneoaytoma/blastoma

Asbocytona
6.Cellar/Suprasellar Region Skull base &Stnuses
Carcinoma - nasophayngial
Pltut t a y adenoma
Stnuses, ear
Cvantopharynglonma
Meningioma Ccareinoma tous meningtts)
Optic neve liomaa Chordoma
Glomus jugulare tumour
Epi deyrnoid /Demold cyst.
Ostedma Cmucocele)
 Clinical features tion
depend on tumor
Size, type;loa
mptoms of brain
tumo
and degrte of malignane or the
to haemonhaqe
tumourc pesent acutely due
sonally
development, of hydvocephalus or havms tne
tumnIN S s e s
on neave
mptorms Caused Whena
at
Pat of brain Most common symptoms
Vislon, heaing
Headache Cworse in moning) changes in speech,
Problems balanting/ Walking
Papilloedema in mood, personaliby o
Nausea g Vomitingg Changes
Detoviatton of tonscious level ability to Concenbrale
Puptllany dilaton Probleme With memony
due to ised inbvacanial,
ptssure
Muscle eking/twitchinq (selzures)
and Baatn shift Numbness/tingling in ams orlegs

Headache 1t ts the pusenting sumptom in 30 of cases a develops

duing the Course ok disease in 4o1. of Cases. include
Cevtain featurtu ofttn indicate the psence of bxain tumour
Headache that întmupts sleep ov worse on Making and împroves
throughaut the day
or exevCiSe.
( Headachr thaE is elkcited by postuval changes, Coughing
than
is moe Severe ov of a different tuype usual
git Meadache of cent onset

h e ntw onset of headache in a p«viously asymptomatic pevson.

the Headache associated with nausea, Nonmi ttng, papilloedema o
focal nuological sgns
2. Selzure1t is the prsenting symptom in Jad of Casess pesen
in 50-7o/ of tases at Some stage of disease

adult lith new onset selzure actívity have brain

Appvor to-201
in
tumours Seizures produced by glioma
fontal lobe. (sa4)
Parietal lobe tHa1)
Ternpoval lobe (354)
Occtpttal lobe (33-)
is the initial symptom in Is. to 2o-
3. Alled mental Status-1t
of tndividuals

Slught changes in concentatton, memony, afto pexsonality,inttiative

& absbsack reasoning to Sesve toqnitve problems Con fusion.
 Popoey ai- Sdltné ot. optie neve is less, fequent, n oa-
a days
because bratn tumours ant being dlaqnosed. easlier Wth he use
becau
o Senstive tmaging techniques.
1s mov Common in
chtldren wth sloud
and
Posteaior tossa tumou groung
Massettes incude untorial s tonsillas hemiation, CSF OsTI
obstuction tn Supatentonal & inkrattntorial tumaurs spectively
Epiers CetDral Cecbellar, distuxbed finctions, cvanial newe
damaqe Of-i &- tn
ocuy focal damag
Specie Signs s Sumptoms in dtstusded functian
Supva tentonal
Gontal lobeContralakval -face, am /leq weakness
Epesstve dusphastá tdominant hemisphert)
resonaliky charges Ikkeanti-Soaal behaviDuT,
loss of nhibiions
loss of nttiative
intellectual tmpaíment
Hemipasis, aphasia e gait dtffhaulies
Seazurts
PrD found dementia it copus collosum is învolved.
touch
Parietal lobe:- DIsturbed Sensatiorm localtsation of
Pofnt discaimination
, Passive movement
4Seeognosts
Sensovy inattention
MSual feld deecb - lawer homonimous Quadran tarapo

Dominant hemisphen : Kightl lett.contuslon NonDominant, Sensony/

inger agnosia hemispheve motor,

Acalaulia neglect
Agraphta DSSing apvaaia

3 Occtpttal lobe VISual felddefcct- tHomonymous Hemlanopla

Paieko-ociptal junction; Vtsual agnosla, agaphia
Blatval tumaur : Cotical blindness.
A. lemporal lobe lesion clinttally slent until they become
Anttnor
Vey larqe Causing Selzues.
Laleal,;auditoy Perceptual changes
Medial:Cognttive integration changes:, LT memony, leamng
 ominant lobe Receptive
dysphasid,Aphas
tett tober Anoma, Aqraphia, acalaulta, leni cke apha sia
Bilempova involvcment -bae) memony.de his dementia
uPper hormonymous quadrantaropia.
Hypothalamu / pthuiamy Endocine dystunction
Copus CallosunDysioninection Syndhome Apraxia, blindnss
Supalentonal tumouns may dictty danage 1 lI Cranial newes

Stnus tomp»ession /tnvasion mau involve - tranial neves

Cavemous
Infrattntosial
Cecbellum - Headacha nausea vomiting, a ttinia
Tuncal &gait ataxia, appen dicular atania 7.

pstlaktral dysmetria, dusdiadochokinesla, intention

tmor

Hearing loss, facal palsy, Dys qthria, Nystagmus

*Ceibellar tonstl hemcrtlon,nuchal igidity.
Boain StumGait distubances
P!plopia Midbain- eR -
fotal weakness
esions
Headach, Vomting C1otnnsic,long bract Signs
feacial numbnéss g Weakness
(motor &sensony)
Pexonality change Dekuyi oiction of
favinaud Sndvome Consclous lerel
Pons &medulla - Apnea Tacmor
hypo hyptr ventilationm mpaitd tye movcmen
othoste hypotnsivn/ Suncope Puptllany abnomalitts
3 Rtuttany glard Dectases homone produetion
Nomiing, Hiccough
Cushings disease
hypothuoldisn
addis diSease
Dhibélee ete
takal etnsion 3d uth cN: Diplopiaa
5th N 1psilattal faetal rumbness

Cexba întartion: tCA octusion

upward extnciom CempresSes optic chicsma & typothalamus
Downward extenston-Cormpisek sphenotd Stnus.
1nNestigatioD
metastotic
umou as
chest
c h e s t

CRPThe high incidence of

tntratrantal tumou
these ess mandatoy patiens nith
Suspectd
(1) Osteolyie leslon
ul -ray ()
Sku
Calci-fication Paimany/ Sec
bone
tumouy

oliqodendogioma Dexmoid/Epidesmoid

Mentngomaof adjatent bone) chovdoma

N a s o p h a y n g e a l Cancinoma
tyPerstosit
Cando phanmgionma
Myelomo
Reticulosis
clinoids
)
Bealen brass appearance
Bea postrior
of
Value stnce 1t may OCcuN (v) Eoosion
larniled adulls.
in childrtn & in some
C r a n i o p h a y n g i o m a

nomalluy Ctocal prtssurt)

Sutu Seperaton ediastasis)
tntracranial prtssuYt
Sign of. raistd
in infan.
(i) Mass effect
CT Scan
midline shift
ste:Fontal, Ocriptteall
Ventmcular
brain Substance
Erdinstc :Out with
Compsslon

Meninqioma -Hydvocephalus
basal
adjacent bone bliteration of
Hyperstoss: Effect O
on
Cis ens

: Aithin brain paenchyma

TotinsC
Scans
Astsoytoma
hgh Definition width)
multiple lestons C tmm slide
(i) Stngle or in the
dettction of
metastoasis. Useful
Pituttay, Orbital and
Etkct of lontsast enhancement Pbskrior tossa tumouts.

astrocytoma
E None: low qrdde
intgular :Malignant ashoy0
tHomoqenous : Meningioma the
demonsbraing
Reconstuction -Use-ful in
Covnal Saggital other Stuctures,
tumour its velationship Nith
Vertical eittnt of a
fossa
Nhen
inraventriculaY or aising from pituitary
especially
Skull ba6e. exact amtomical velationship
Scanning provide
Covonal a Sagital
t v Ventides, the falx g the
Of umour to
the Sulci e ud,
cevebelli n MRI.
lentoviuum
 MRI Tt is of payticular Nalue in tumours of Skun base
Cranio ceial junction e brain Stem Vessels to
bloocd
Flow voids show t
relatonship of adjacent
th tumour
incHases
IOKdmagnetic enhancement Intrave nous gadolinium
of detecHon clav ies the site of ongin, 1e, intns
nsivity bebween tumour 4
extinstc and may. delireate the border
Surounding Oedema c
more Sensitive than
nge mulHple lesions MRI a p p e a s
o
the delechio
Smalt. tumouns improves
Canning in dentifylng
o multiple lesions. Eg- Metastasis
to Supplement
nglography /CTA/MRA 1t s ocastonally requînd. Vessel displatement
Ote vestigations as tt eveal a turrur blush ox

in Some patienis.
povides useful poperative nformation
tunou'T
Vascular
ETdentifes feedng Vessels to a
tumous involvement in constbicton of major,Vessels.

Thallium SPECTHelps to ldentify of h1gh.grade activity

sites
lithin a tumaur Useful to exclude if propostng conservai
management or In planntng Steitotacic biopsy
aitas toD
tunctional MRI shows the velationship of eloquent
the tumour. may aid veseckion
Used to identify -ftbre tsacs running
MR Diffusion TensoY Imagin
în planning
adháceht to ov thwough the tumour. Poential Value
Operatve tsection
is tonbrainditaltd in intacranial
CSF examination Lumbar puncure like
tumour Suspeciom If CSE iSobtaned by other Source,
VtntriulaY Drainage or duing shunt insertion, then atological
tumour cels.
examinatian may, tveal
the link bebween. elevattd
o- fetopavein
Tumour mdkeis. Only &
human choxionic gonadobvphins
Nith Yolk sae tumouYS
Choiocacinoma of d Ventmde hetps diagnosis
lestons
Difftrential Diagnosisof mass
Vascular- Hematoma
Infectiom-Absess
Cyss
tubtruloma avachnoid
i a n t aneuysm Sarcoldosts
infarct uwth oedemna Pavasttte
axkiovenous malformartion Taum.ephalris

Venous th»vmbosis Contusion

 Management Suounding

Seoids dramotically veduce oedemo sumo

Sttroid Therapy
inbracranlal tumouNS, but do not atfect turmour grouwtn:
H n9
denamethasone followed by
A loadng dose of 18 mg iv
OTallyor by injection H tmes
a day (q.1d) of ten TeveTSes
oqrtssive clinttal detoiaton Nithin a feuw hours
t i o n m i n i m i s e s

dose reduction minim

After Several days ttatmen, qradual
the s k o unuwanted Slde effecs. Mtth Se
seid

tumours occasionally pesent

|Sellar parasellav cover 1s a n essemtia
e t i a l

In these patient, stevoid

insutfhiiency.
anaesthetic or Operative prd(edure
Prtrequlsite of any
2Operahve Management
reflectd. if necessay
bone cut and
Ci) Craniotomy Flap of t h e +lap
to aid positiontng
Combined Wih tmage quidance
leston lotaltsation.
accurate
&to qtve stnus to
the
oule hrough the
sphenoid
) Transphenold
Ptuitay fossa odontoid peg &
oule-Removal of arch of atlas, o f brain slem
skm
brain
CtdTransoral to the anlerior aspect of
acess
Clvus provides
upper cervital Cord
tumours.
ankiorly siuated
rtquired tor
Ravey
Neuv Abromas, chordoma
hand held,
ulbrasound quided biop Sy.
fo slereotacic ov
Bur hole bone
Cv by removal of surounding
)Cyanieckomy Bur hole followed
the poskvior
-outnety used to approach
he LiposuTt
to extend
fossa Parhal tumour emoval,
paoceduves: Biopsy,
The Cubsequent intemal decompsSOT Complete vemoval

on naturt of tumouY &ttt stte

Depend pxvent
nature of pimany malignant tumours
The i-fltsatve Testntled to biopy or tumour
emoval oHen operdtion is
Comdete
decompession. with
with benign tumnou
benign tuouNS Suh as
removal im
.Prospecfs ot Complele
meningioma/ Craniophauy ngioma. m a í n attached to deep
is ovevlooked /if fragmns
any tunour
t f any
I
sthucture s, then e curenca will result
 mage Quided Surge -the tumaur site on pe
-

Tt is essential to
acurately identify this tn-fomatibr to
intomakion
this
able to use
be
Opevaiveimaging & to Nhether tor
iopsy
blopsy or -for
or for
Fuide t h suwgeon to
the -the tunour
Fuide
resection frame to the
the trame the
attathing-the
Suxqery-By igidly the positio
StereotacHe MR to ldentit
a cT ov
Patient's head and using a Selecked
detxmined for
Coovdinates a r e needle to.
CT locang. ods,
accuvate placement of a, biopsy eec
tavqet alloutng
Alithin
Atthtn tmm Selecked pofnG
to biopy
.This dhnique fs routinely used
h umouT. tumour
resecion
nith
caniotomy
&
t 1s posstble to perfom to tmpede access
but the tramne tchds
he trame tn place, shift intoducing
shitt tntoductng
brain may
afler opentng the bone -flap, the
erors of localisatton. neLvonavigation

is plained, most no USe

a craniotomy
iqid -Auation ót had
Nhen

NeuvnaviqationThis
techntque requíres
(i0
head holdes.
Standayd 3 ptn handheld
posttton ot -the
in a
delects the
This System accuraily to See
skull allows the Suvqeon
Paobe tn velation to the
kes in elation to prt Opera
tive imagirng.
Nhee he probe tip biain.shtft
biain.shitt
to take into ,account
Thi tchnique also -tatls bone ftap or if CSF iS
opening te
h i c h can o c c u r on
-Ihu Umtting accvaey
drained off
Imaging I overomes problems
(tct) Real- time tnba-0perative
& not Only helps to locate
the
encounttred Nth brain shifE
extNE ot tumauy esection as
umour i t also Choosthe.
the Operatton poqreses
NuYonavigation to
ulbracound ha: been Combtned With
at.a mpre ealfstic expense.
Provide eal- time Imaqing

Surgey n Eoquent Arras le

lie adhacent tolhin etoquuent
aras
tumours
Nhen intrinsic inttmal capsul, HsSectiont
motor Stip, bdsall garnglia &
Speech arta,
Vaiout echniquues developed to minmise visk
is hazardout.
 MRI/DTI (Tractography) Supeximpostng speech/motor st*p
Seen on
artas

fMRI Whitë matttr tracts Seen on tractogrpi

on o h e Standard MR Image, denonstrates the dationchip o

Aumour to
these Cucial Stnuckurts
neu0-nav{gation
henthese images ave tncorporattd tnto the
the
Syekm i enables the Surgeon to avoid extendtng
turnour Seckion into these artas Causing ire Verslble
nuologital deftut.
(10 Awak Craniotomy By ether perBoaming the Surgeny klholy
With local ances thetic
or giving a n
by
under Sedation
the cranlotomy & Naking
anaesthetic -for Opening Closing
the patienE up in bctwen, gtves theSurgeon h e Opportuny
Stmulatlon

to tdentHy eloquent areac by applying electical etfect

functional
dixct to the cotical Surface & obsening
umouY
well &maximal tumour
Pathenz tolevati the tchnique
Patien
reSeckion is possible ith
a low sisk of defid
uEurses
3 Radiothesapy tumours with
radiotherapy
IntrcLCranial
Tatment of
X- Yays 0))
0) Megavoltage linear acceleratoY (produce
Git) Electson btami
from a
tHe, protons)
toom a yclotron. (nuclet of
() Aceleratës patids
6o
Cobalt
v) raus trom technigues poduce
mithods, moden
I n Contrast. to older adiaHon damage
to Skin
avotd
tissue penetsc1tio
grear
the total dose - usually
Suface on
radliothetapy depends
T h e effcct
oE
durathon
teatment stnctures.
6o y, i s k to nomal
upto aganistthe
balanced dose to a
th
T h is must be
s must the highest posstble
to provide nomal
xatment atms
tradiaton
to ddjacent
lhilst mintmisng
Specihed eqio

brain been developed to achieve thts.

have
Various metheds rddio therapy is adminislete
Alhert standard
(1) Confomal therapy
of Navlable Collimators/
but th beams are shaptd by the use
block&
 Whch ton-fomm ith the shape of tumouyherby ellminating
nomal bxain.

(1) Sertotacte Radio surqeny CSRS) Nhert multple Conveqinq beam

om a tneay accelevator or tom muttple Cobalt "SoureAs
bratment
on
ae-focuSed a selecud target in a Stnqle
localisatiot
Sernotaci Radtotherapy Cst) uses the same
tn
method but Nth frachionattd tcatment as used
Conventional radiotherapy. fom
1s ttatd
() InkersHtal tchnigues wihe the tumour
tmplantatiorn of multiple radionthie
Hhin (brachuttheapy) y he
Seeds. ay Todine s USes non-unitom
vadiotherapy CIMR)
Beam tntenstty modulated tumour Volumes.Thts
to complex
bedms o Vansinq tnensty higher dose
e t allouos
a
stuctures,
Sumounding
nelps protctd doses of radiativn
allous the deliveny of hgh
() Proton theapy to Vtal
Stucturts Such as
localised *gons adjatent
Ven
Skul basu
the management of malgant
Kadiothevapy is of pästialaY Nalue tn
tumours.
umors a& of Some bentgn
MalignantAstootoma"s9hBenign Prhttay adenoma

Cxaunto phayngioma
Metastasts ol
Medultoblastoma 23tpgstors ()
Geminoma Nhote
thvoughout the CSF pzthuoaus,
NH Some
umoüs that Seed Yecuriene
minimises the k , of dístant
neiural axis adiatlon
E - M e d u l l o b l a s t o m a

deteriovatibnu in petient's condtonu

tæatment,
Complicationg -folowing
-ReverstbleE
Tncnased Oedema-Ding beatment
Reverstble
Demyelnation- afkr weeks, months
montheloys)-IRercrstble
n

3. Racdtone.costs yr C6 i
dementia
radiction causes
Nhole brain
H ogntthve
impaiment- ghould be
Otala a tnwntinence CRodiotherapy
avolded in 3yrs)
afkr' tcatrment
5, Radtation tnduced umous, Result many yea
Oedema, Demylelnation, Yadionecosts other etftck; atrtoss,
ord afte tadiatton of ,SeIN Kactons, enolocin
fnvolve Spinal Spnal tumauk. dustubante
4Chemothexapy

chermotherapeutic agenís management of malignant brain tumous

in the

but the benefis emain lîmiled Most commonly used dugs

are

Nibo sourt0s Ceq BCNU, CCNU),

Procarbaztne, Vtncisine,
.Methobt1ale (tymphoma) extelent blood biatn
eno2olomide,
an oval alkylaHng agent wih an
as
modest toudty is establshed
bamer penebrationm and grade qltoma
bcatment for patients With
rtcurtnt high
ghoblas toma
attematve

tmprovt Suvival for patens uith newy diagnosed

Also
Whe qiven concomítanty with 7adiotherapy
thevapygltoblastoma
Maimal Sa Suge+chemoradio
of MaMT g¢ne
Particulay beneftt to patiente With methylation
tumou (Gladel) consedered both as a poinmaa
Caxmustne impregnatëd Nafers
btatment /for tumouv veunence. With
oltqoastrotytoma
Nth anaplaste okepdendvoglhomas &
Pa tients chvormosomes 1p l2
& have a goad prognos
lost of helkvozygostty on
to alkylating agent
based
adiatom a
respond well to both
on chemo therapy Cntbrosounas) at xlapse.
etther at tnikiat dlagnost or

therapy may be used

Chemo an împortant role
Dther umours Whne chemo thempy plays
ymphomas qem cell aumour
pimay CNS
ncude medulto-bastomas,
s use in both astroy bomas
>Curtt shudis a e examintng
alttnahre to radiaton in newly diaqnosed
as an
oltqodendvoqltomas

Problems o Dug odrntntsbraton

Causes bone marou
Toxicthy-igh dg dosage tquently
limit yevtoxic acvity before an ddequalee
SupprtSston Whtch may
dose ts wached.
terapeut Sufhient amouns
acess1Oxie doses art tquted before Cell.
.Dug access tv umou
baier & qain
Penebrade the blood-brain to have a
Cnn
tumour e lls appeaY
3. Intinstc
Resistance s Some available
The Vast ayray of
to certain dtas.
nbutl Eststance Of Combined therapy
he in fnie pemutations
Ceyto toxie dnugs 8
Creatis diffiulties tn daug Selection