Neuro-onkology · Clasification Acta Neuropathol. 2007 August; 114(2): 97–109. Published online...
Transcript of Neuro-onkology · Clasification Acta Neuropathol. 2007 August; 114(2): 97–109. Published online...
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Jaroslav Jeřábek
Neuro-onkology
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Incidence 4.5-13/100 000• 80% supratentorial (1/2 metastic)
• Frequency: metastases, glioblastoma
• Childhood: max.primary (70% infratentorial (3/4 cerebellum, ¼ brainstem)
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Clasification
Acta Neuropathol. 2007 August; 114(2): 97–109.
Published online 2007 July 6. doi: 10.1007/s00401-007-0243-4
PMCID: PMC1929165
The 2007 WHO Classification of Tumours of the Central Nervous System
David N. Louis,1 Hiroko Ohgaki,2 Otmar D. Wiestler,3 Webster K. Cavenee,4 Peter C. Burger,5 Anne Jouvet,6 Bernd W. Scheithauer,7 and Paul Kleihues8
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Metastic tumors• CNS parenchymal - mamma, lung,
melanoma
• hypofyseal- lung, melanoma
• meningeal- lung, prostat, mamma
• skull - mamma, prostat, osteosarcoma
• Spine- lung, mamma, prostat, colorect.
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Symptoms• Localising: ep, fatic, hemiparesis, visual
field defects
• Nonlocalising: headache, unsciousness, changes of personality, attention, memmory, vertigo, papilary edema
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Be aware of tumor
• Headache- 60%
• Epilepsy- 30%
• Progression of focal signs- 20%
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Progression of focal signs
Chiasma
Bitemporal hemianopsy
Hormonal changes
• Prolaktinom
• HGH – akromegaly
• ACTH – Cushing
• hypopituitarismus
Haemorhage in tumor = acute signs
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Headache
• night, in the morning, worsened by Valsalva maneuver
• Change of type of chronic headache
• Persisting “aura”
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psychologicalchanges
• personality
• memory
• organic psychsyndom
• pseudoneurasthenia
• behaviour - agressivity, passivity
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Epileptic paroxysm
• CAUTION: secondarity
• MRI
• CAUTION: non-contrast CT
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Neurologic signs
• Neurostatus can be normal
• Hydrocefalus- infratentorial tu
• Brainstem symptoms
• Foster-Kennedy: visual loss+ contralat. papiledema (meningeoma os.sphenoidale)
• Hemichorea: BG (astrocytoma, lymfoma)
• Everything
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Spinal tumors
• Intramedular (ependymoma, asrocytoma): pain +, sensitivity-, sphincters, spasticity, pyramidal signs
• Intradural, extramedulary(meningeoma): pain + - +++(meta), radicular signs - paresis, pyramidalsigns
• Epidural (meta): pain +++, radikular sy
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Neurosurgery
• Biopsy
• Localisation malignanacy
• Internal tumor decompression
• fMRI
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Radiotherapy• Radiation
• Radiosurgery- gamma knife, X knife, Novalis robotic 6D system
• Postiaradiation necrosis
• antiedematous treatmen (steroids)
• myelopathy (radiation)
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Chemoterapie
• Součást kombinované léčby
• Tumory NS většinou nepříliš sensitivní
• definovaná schémata
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Conservative treatmentICH• Dexamethazon inj. a tabl.
• Mannitol
• Glycerin
• Arteficial hyperventilation
Antiepileptics
Psychotherapy, rehabilitation, etc
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Outcome
• Type, lokalisation
• Glioblastoma - 12-15 m.
• Meningeoma - rarely reocurring
• Watch and wait (schwannomas)
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Don´t forget !
• Headache- 60%
• Epileptic paroxysm- 30%
• Progression of focal signs - 20%
• Neuroradiology