BRAINTUMOR医学教学课件

1、Brain tumor第1页，共72页。What is brain tumor?Intracranial tumor Craniocerebral tumor第2页，共72页。Brain tumors are the:leading cause of cancer-related deaths in males ages 20-39. fifth leading cause of cancer-related deaths in women ages 20-39.第3页，共72页。Teaching GoalContent to master:1.Common clinical charater

2、istics of cerebral tumor; 2.Diagnosis and therapeutic principleContent to be familiar with:1.Classification of cerebral tumor;2.Main clinical manifestations of various brain tumors3.Etiology and epidemiology第4页，共72页。Classification of craniocerebral tumors1.Scalp tumors (less, angioma, melanama, neur

3、ofibroma, basaloma)2.Skull tumors (less, osteoma,multiple myeloma,fibrosarcoma,dermoid and epidermoid) brain tissue meninges primary cranial nerve 3.Intracranial tumors intracranial vessel embryonic tissue Metastatic from other organs 第5页，共72页。Primary brain tumors1. Neuroepithelial tumors (gliomas)(

4、神经上皮肿瘤、胶质瘤) Astrocytomas （星形细胞瘤） Oligodendroglioma（少突胶质细胞瘤） Medulloblastoma（髓母细胞瘤） Ependymoma （室管膜瘤）2.Meningioma （脑膜瘤）3.Neurofibroma （神经纤维瘤）3.Primary cerebral lymphoma （原发性脑淋巴瘤）4.Pituitary adenoma （垂体腺瘤）5.Tumors of other tissues Blood vessels: haemangioblastoma（血管母细胞瘤） Germ cells: germinoma（生殖细胞瘤ter

5、atoma（畸胎瘤）. Tumours of maldevelopmental origin: Craniopharyngioma（颅咽管瘤）,epidermoid（表皮样囊肿）/dermoid cyst（皮样囊肿）第6页，共72页。Epidemiology1.Annual incidence : about 8.2 per 100 0002.Accounting for about 5% of all neoplasms in the body3.Make up approximately 50% of all childhood malignancies.第7页，共72页。4. Diffe

6、rent primary tumor types and their anatomical location varies with ageAdults: gliomas, meningiomas. 80-85% supratentorial compartment. 15-20% infratentorial compartment.Children: medulloblastomas, cerebellar astrocytomas 40% supratentorial compartment. 60% infratentorial compartment.第8页，共72页。5.Incid

7、ence distribution of primary brain tumors第9页，共72页。6. Incidence of distribution of all gliomas by histology subtype第10页，共72页。EtiologyWhat factors can cause brain tumors?1.Genetic factors2.Physical factors 3.Chemical factors4.Biological factors第11页，共72页。clinical manifestations depend on the site of th

8、e tumors and the speed of growth1. Features of increased intracranial pressure1）headache2) Vomiting3) Papilloedema 第12页，共72页。2.Focal symptoms and signs depends on the anatomical site whether the tumor effect is irritative or destructive.1)Benign: slow growing, mild edema2)Malignant: fast growing, ag

9、gressive, severve edema第13页，共72页。3. clinical manifestations of lesions in the cerebral hemisphere EpilepsyMental symptomsMotor disorderSensory disturbanceAphasiaVisual field defects第14页，共72页。 Epilepsypartial seizures simple partial seizure complex partial seizuregeneralized seizure第15页，共72页。Paralysi

10、sMuscle strength grading scale0/5No contraction1/5Visible/palpable muscle contraction but no movement2/5Movement with gravity eliminated3/5Movement against gravity only4/5Movement against gravity with some resistance5/5Movement against gravity with full resistance(normal)第16页，共72页。Aphasiaagraphiamot

11、or aphasiaBrocas areaWernickes areaalexiasensory aphasia第17页，共72页。4. Clinical manifestations of lesions in the sellar region Decreased vision Visual field defects Endocrinological symptomshypopituitarismHyperprolactinemiaAcromegaly/gigantismCushing,s syndromeThyrotoxicosis第18页，共72页。5. Clinical manif

12、estations of lesions in the pineal bodyObstructivehydrocephalusVertical gaze paralysisParinaud syndromepineal body第19页，共72页。precocious puberty(性早熟) Dysfunciton of midbrain,cerebellum and hypothalamus第20页，共72页。6. Clinical manifestations of lesions in the posterior cranial fossa Cerebellar hemisphere:

13、ataxia in the ipsilateral limb Cerebellar vermis:equilibrium disorderCerebellopontine angle area:damage the ipsilateral cranial nerve V- and cerebellar hemisphere.第21页，共72页。Clinical characteristics of different types of intracranial tumors第22页，共72页。1.Astrocytomas(星形细胞瘤) the commonest primary brain t

14、umors.occur at any age, the commonest in the ages of 40-60 years.Male/female incidence is 2:1.occur with equal incidence throughout the frontal,temporal and parietal lobes,but are uncommon in the occipital第23页，共72页。 Four pathological grades (Kernohan I-IV):grades I and II： Low-grade astrocytoma . co

15、mmonly seen in children/young adults.grade III :Anaplastic astrocytoma .grade IV: Glioblastoma multiformis Malignant astrocytomas are far more common than benign ones.第24页，共72页。pilocytic astrocytoma(grade I)F, 14-year-oldpreoperationpostoperation第25页，共72页。preoperationpostoperationastrocytoma(grade I

16、I)F, 40-year-old第26页，共72页。PreoperationPostoperationBrain stem astrocytoma(WHO III) 10-year-old boy第27页，共72页。preoperationpostoperationGlioblastoma multiformis (grade IV) M, 50-year-old第28页，共72页。2. Oligodendroglioma slow-growing / low malignancy. younger age-group (30-50 years). common in frontal lobe

17、. Imaging reveals a well- demarcated tumor, frequently with areas of calcification.（少突胶质细胞瘤）第29页，共72页。3. Medulloblastoma（髓母细胞瘤）the most common malignant tumor of childhood (4-8 years).arises from embryonic tissue in the cerebellar vermis.may seed through the CSF pathways to other parts of the craniu

18、m or the spinal cord.第30页，共72页。4. Ependymoma（室管膜瘤）the second most common tumor of childhood.occurs in the ventricular system or the spinal canal;common in the fourth ventricle and in the caudal part of the spinal cord. 第31页，共72页。EpendymomaIn lateral ventricleIn fourth ventricleIn medullary cone第32页，

19、共72页。5.Meningioma(脑膜瘤)A benign tumor arising from the arachnoidCompresses rather than invades the neural tissues. Maximum incidence occurs in 40-60 years of ageImaging reveals a well circumscribed lesion with occasional calcification.第33页，共72页。Common in:sylvian region, parasagittal surface olfactory

20、 grooves, lesser wings of the sphenoid, tuberculum sellae, cerebellopontine angle, thoracic spinal cord第34页，共72页。6.Neurofibroma(神经纤维瘤)a benign, slow-growing tumor.develops on the vestibular division of cranial nerve VIII commonly(misleadingly called an acoustic neuroma).sensorineural deafnesstinnitu

21、s and vertigo.第35页，共72页。 It may appear as part of the neurofibromatosis syndrome ( type 2),when other tumours (particularly contralateral acoustic neuromas) should be sought.neurofibromatosis syndrome 第36页，共72页。7.Primary cerebral lymphoma aggressive tumours account for up to 10% of central nervous s

22、ystem complications in AIDS patients. often periventricular,and may be multiple.第37页，共72页。8. Pituitary adenoma （垂体腺瘤）a benign tumorpresents with neurological or endocrinological symptomsSome smaller tumors present with hyperprolactinemia or acromegaly/gigantism, Cushing,s syndrome or thyrotoxicosis第

23、38页，共72页。 Large pituitary adenoma usually presents with headache, bitemporal hemianopia (from upward pressure on the optic chiasm ),and occasionally hypopituitarism.？第39页，共72页。Congenital benign tumorStem from cranial pharynx tube residual tissue in the pituitary stalk in embryonic periodCommon in ch

24、ildhoodMostly cysticMany postoperative complications9.Craniopharyngioma（颅咽管瘤）第40页，共72页。10.Haemangioblastoma（血管母细胞瘤）Benign tumorLocated in the cerebellar hemisphereHave a genetic predispositionMostly cystic with a rich blood supply of nodules第41页，共72页。11.Germ cell tumor（生殖细胞肿瘤）A variety of pathologic

25、al type:germinoma,teratoma,endodermal sinus tumor,embryonal carnioma,chorionic epithelioma,mixed germ cell tumorCommonly Located in pineal region and sellar region70% have occurred in ages 10-24Spread easily with CSFSensitive to chemotherapy and radiotherapy第42页，共72页。12.Metastatic brain tumors（脑转移瘤）

26、Metastatic brain tumours are around 8 times commoner than primary ones.About 20% of patients dying with other tumors will have intracranial metastases.The primary tumors are: 44% bronchus 10% breast 7% genitourinary. 6% bowel 3% skin (melanoma) 30% others. 第43页，共72页。Diagnosis Localization diagnosis

27、Qualitative diagnosis 1.Clinical diagnosis: intracranial hypertension, seizure2.Image diagnosis: CT,MRI,DSA,PET,SPECT3.Electrophysiologicalexamination: EEG, cerebral evoked potential4.laboratory examination: anterior pituitary hormone,HCG,AFP第44页，共72页。normalglioma1.magnetic resonance spectroscopy(MR

28、S)第45页，共72页。2.functionalmagneticresonanceimaging(fMRI)Show relationship between tumor and important area of brain第46页，共72页。3.magnetic resonance diffusion tensor imaging(DTI)Showstherelationship betweentumorsandthevital nervefiberbundledirectly第47页，共72页。Treatment1.Symptomatic therapy dehydration medi

29、cine ,steroids (to reduce cerebral edema),anticonvulsants.2.Benign tumor: Surgery3.Malignant tumor: multimodal treatment (surgery+radiotherapy+chemotherapy)第48页，共72页。Routine craniotomy 常规开颅术第49页，共72页。Routine craniotomy 常规开颅术第50页，共72页。externalventriculardrainageventriculo-peritoneal shunt operation第5

30、1页，共72页。Advanced techniqueMicroneurosurgery第52页，共72页。Endoscopic techniqueEndoscopic resection of pituitary adenomaEndoscopic third ventriculostomy第53页，共72页。Neural navigation neurosurgery第54页，共72页。Intraoperative awaken and cortical electrical stimulation technology The patient remains awake during op

31、eration and accepts the cortex stimulation, which is easily for neurosurgon to judge the functional region of brain. The technology can reduce the damage of brain function as much as possible.第55页，共72页。Intra-operative MRI第56页，共72页。Intraoperative neurophysiological monitoring第57页，共72页。Radiotherapy1.H

32、ighly sensitive to radiotherapymedulloblastoma, germinoma, lymphoma2.Maglinant glioma1)Strongly recommend regular fractionated irradiation as the standard therapy for postoperative glioma2)X or r knife is not recommended the preferred treatment for glioma3)Recommend starting radiation therapy as soon as possiple 2-4 weeks after surgery.第58页，共72页。ChemotherapyAt present the most commonly used drug is : temozolomide