CNS TumorCNS Tumor

Intracranial tumors can be Intracranial tumors can be classified in different ways:classified in different ways:

1. primary versus secondary, 1. primary versus secondary, 2. pediatric versus adult, 2. pediatric versus adult, 3. cell of origin, 3. cell of origin, 4. location in the nervous system. 4. location in the nervous system.

the incidence of primary brain the incidence of primary brain tumors tumors

14.8 per 100,000 person-years 14.8 per 100,000 person-years

Clinical Presentation Clinical Presentation

The clinical manifestations of various brain tumors can best be divided into those due to focal compression and irritation by the tumor itself and those attributed to the secondary consequences, namely increased ICP, peritumoral edema, and hydrocephalus. Most commonly, symptoms are caused by a combination of these factors.

The clinical presentation does not The clinical presentation does not differ much by tumor histology differ much by tumor histology but rather by rate of growth and but rather by rate of growth and location of the tumor.location of the tumor.

Headache occurs in 50% to 60% of primary brain Headache occurs in 50% to 60% of primary brain tumors and in 35% to 50% of metastatic tumors. tumors and in 35% to 50% of metastatic tumors.

The headache is associated with nausea and The headache is associated with nausea and vomiting in 40% of patients and may be vomiting in 40% of patients and may be temporarily relieved by vomiting, as a result of temporarily relieved by vomiting, as a result of hyperventilation.hyperventilation.

Seizures may be the first symptom of a brain Seizures may be the first symptom of a brain tumor. Patients older than 20 years presenting tumor. Patients older than 20 years presenting with a new-onset seizure are aggressively with a new-onset seizure are aggressively investigated for a brain tumor.investigated for a brain tumor.

Location of tumorLocation of tumor

Infratentorial lesionsInfratentorial lesions Supratentorial lesionsSupratentorial lesions Frontal lobe lesions Frontal lobe lesions Temporal lobe lesions Temporal lobe lesions Parietal lobe lesions Parietal lobe lesions Occipital lobe lesions Occipital lobe lesions

Frontal lobeFrontal lobe tumortumor

Central grooveCentral groove

Central grooveCentral groove

gliomaglioma

Temporal lobeTemporal lobe tumortumor

GliomaGliomameningomameningomaMetastatic tumorMetastatic tumor

Parietal lobeParietal lobe tumortumor

Parietal lobeParietal lobe

Contralateral visual field deficitsContralateral visual field deficits

Occipital lobeOccipital lobe tumortumor

RadiologyRadiology

1. CT scan 1. CT scan 2. MRI 2. MRI 3. MRA 3. MRA

Therapy of brain tumorTherapy of brain tumor

SurgerySurgery

Radiologic therapyRadiologic therapy

ChemotherapyChemotherapy

ImmunotherapyImmunotherapy

Surgery Surgery

The primary goals of surgery include The primary goals of surgery include histologic diagnosis and reduction of Ihistologic diagnosis and reduction of ICP by removing tumor. CP by removing tumor.

Primary tumors of the brain are Primary tumors of the brain are divided into divided into intra-axial (those intra-axial (those arising from within the brain arising from within the brain parenchyma) or extra-axial parenchyma) or extra-axial (those arising from outside the (those arising from outside the brain parenchyma).brain parenchyma).

Intra-axial Brain TumorsIntra-axial Brain Tumors The World Health Organization (WHO) classifies intrThe World Health Organization (WHO) classifies intr

a-axial brain tumors by cell type and grades them on a scale of a-axial brain tumors by cell type and grades them on a scale of I to IV based on light microscopy characteristics that include I to IV based on light microscopy characteristics that include degree of cellularity, pleomorphism, mitotic figures, endothelidegree of cellularity, pleomorphism, mitotic figures, endothelial proliferation, and necrosis. The higher the grade, the more aal proliferation, and necrosis. The higher the grade, the more aggressive and malignant the tumor.ggressive and malignant the tumor.

Intra-axial Brain TumorsIntra-axial Brain Tumors

1. 1. Astrocytoma Astrocytoma 2. Oligodendroglioma 2. Oligodendroglioma 3. Ependymoma 3. Ependymoma 4. Primitive Neuroectodermal Tumors 4. Primitive Neuroectodermal Tumors 5. Hemangioblastoma 5. Hemangioblastoma 6. Primary Central Nervous System 6. Primary Central Nervous System

Lymphoma Lymphoma

Astrocytoma Astrocytoma

脑干肿瘤 MRI 片 (失状扫描 )

脑干肿瘤 MRI 片（平扫）

四脑室肿瘤 MRI 片（平扫）

四脑室肿瘤（冠状扫描）

Extra-axial Brain TumorsExtra-axial Brain Tumors

1. Meningiomas 1. Meningiomas 2. Schwannomas 2. Schwannomas 3. Pituitary Adenomas3. Pituitary Adenomas

左侧小脑幕 MeningiomaMeningioma （冠状位）

嗅沟脑膜瘤

左桥小脑角 MeningiomaMeningioma （平扫）

Pituitary Adenomas

Secondary Brain TumorsSecondary Brain Tumors

Metastatic Brain TumorsMetastatic Brain Tumors

Metastatic Brain TumorsMetastatic Brain Tumors

Intraspinal Tumors

Intraspinal tumors are commonly divided into three groups:

1. extradural 2. intradural extramedullary 3. intramedullary

SummarySummary Primary Brain Tumors Primary Brain Tumors Intra-axial Brain TumorsIntra-axial Brain Tumors Extra-axial Brain TumorsExtra-axial Brain Tumors Secondary Brain TumorsSecondary Brain Tumors

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NoticeNotice

Content: Content: Clinical practiceClinical practiceTime: Time: 2:00pm this2:00pm this Thursday Thursday Address: Address: Department of Neurosurgery,Department of Neurosurgery, the 8th floor, No.5 Building the 8th floor, No.5 Building ， ， No.1,hospital.No.1,hospital.