INTRA CRANIAL NEOPLASMNurdjaman Nurimaba dr, Sp.S(K)Neurological DepartmentMedical Faculty, Padjadjaran University

INCIDENCEIn 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

CAUSATIONAntecedent : - 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 yearsCarcinogen : 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

Percent of total

Gliomas :

Glioblastoma multiforme

Astrocytoma

Ependymoma

Medulloblastoma

Oligedendrocytoma

20

10

6

4

5

Meningioma

15

Pituitary adenoma

7

Neurinoma (Schwannoma)

7

Metastatic carcinoma

6

Craniopharyngioma, teratoma

4

Angiomas

4

Sarcomas

4

Unclassified (mostly gliomas)

5

Miscellaneous(pinealoma, chordoma)

3

CLINICAL SYMPTOMGeneral 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

NeuroepitNeuroepithelial tumors :

Neuronal tumors :

Germ cells tumor

Astrocytic tumors :

Ganglioblastoma

Germinoma

Diffuse astrocytoma

Gangliocytoma

Embryonal carcinoma

Anaplastic astrocytoma

Primitive neuroectodermal tumor;

Choriocarcinoma

Teratoma

Glioblastoma multiforme

Medulloblastoma

Malignant lymphomas :

Juvenile pilocytic astrocytoma

Pineoblastoma

Hodgkin's disease

Neuroblastoma

Non Hodgkin's L.

Subependymal giant cell astrocytoma

Meningeal tumors

Meningioma

Malformative tumors :

Craniopharyngioma

Oligodendroglioma tumor :

Papillary meningioma

Epidermoid Cyst

Oligodendroglioma

Anaplastic meningioma

Dermoid Cyst

Anaplastic oligodendroglioma

Neuroepithelial (colloid) cyst

Nerve sheath tumors :

Ependymal tumors :

Schwannoma (Neurilemoma)

Lipoma

Ependymoma

Regional tumors :

Myxopapillary

Neurofibroma

Chordoma

ependymoma

Neurofibrosarcoma

Glomus jugulare tumor

Anaplastic ependymoma

Tumors of blood vessel origin :

Chondroma

Subependymoma

Metastatic tumors

Choroid plexus tumors :

Hemangioblastoma

Carcinoma

Choroid plexus papiloma

Hemangiopericytoma

Sarcoma

Choroid plexus carciaoma

Lymphoma

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

TOPOGRAPHYSupra 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. NeuroastrocytomaBenign 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 EXAMINATIONScheedel photo : - Erosion of posterios dorsum sella - Ballooning sella - Impression digitate Angiography CT ScanMRI

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

PROGNOSISMalignant tumors : Non SatisfiedBenign tumors : Good

HATUR NUHUN