Tumors of the brain

Tumors of the brain . Depending on the histological structure, the brain tumors are divided into gliomas (60% of all brain tumors), meningiomas, neurinomas of cranial nerves (mainly VIII pair), metastatic, congenital and other tumors. With respect to the substance of the brain, tumors can be intracerebral (mainly gliomas) and extra-cerebral (meningiomas, neurinomas), hemispheric, intra- or parasellar and subentorial (tumors of the posterior cranial fossa) by location. Metastases in the brain most often occur with carcinomas of the lung, breast, gastrointestinal tract and thyroid gland, less often metastasize to the brain of sarcoma, melanoblastoma. Most of the brain tumors in children occur in the cerebellum (madulloblastoma, astrocytoma).

Symptoms, course. The clinical picture consists of general cerebral and local signs. General cerebral symptoms are caused by increased intracranial pressure: headache, vomiting, congestive discs of optic nerves, etc. Depending on the histological structure of the tumor and its localization, the rapid development of cerebral and focal symptoms varies widely. Most often, the clinical picture is formed over many months, and sometimes even years.

Focal symptoms depend on the location of the tumor. Tumors of the frontal lobe: changes in the psyche, memory defects, epileptic seizures, speech disorders (with lesions of the dominant left hemisphere), anosmia on the side of the tumor. Tumor paralysis: local convulsions, violation of sensitivity and movements in the opposite half of the body, aphasia in left-sided localization. Tumor of the occipital lobe: loss of sight in opposite fields of vision, visual aura before convulsive seizure. Tumor lobe tumor: psychomotor epileptic seizures, aphasia (with left lesion), loss of vision in opposite fields of vision. Tumor of the cerebellum: imbalance and coordination of movements, early development of signs of intracranial hypertension. With a pituitary tumor - neuroendocrine disorders, bitemporal hemianopsia, an increase in the Turkish saddle.

An X-ray examination is an exceptional and sometimes decisive factor in the diagnosis of an intracranial tumor: the detection of signs of hypertension on radiographs (increased finger impressions across the arch, the destruction of the Turkish saddle), as well as computed tomography and angiography; To recognize metastatic tumors, lung examination is necessary. Gastrointestinal tract, mammography, urography. In all cases of suspected cerebral tumors, examination of the fundus is mandatory. Significant help in diagnosing supratentorial tumors is revealed by the focus of pathological activity on the electroencephalogram and displacement of the median structures in the direction opposite to the tumor in echoencephalography. In many cases, there is protein-cell dissociation, but the lumbar puncture should not be performed outside the neurosurgical department in the presence of severe signs of intracranial hypertension, in particular when stagnant discs are detected. In a similar situation, after the extraction of the cerebrospinal fluid, dislocation phenomena may develop with the formation of cerebral hernias in the cut of the cerebellar nerve and in the large occipital foramen. This complication requires immediate neurosurgical intervention. A similar dislocation syndrome in the form of a sharp increase in headaches and the appearance of signs of compression of the brain stem may occur spontaneously in the developed stage of increasing intracranial pressure.

The diagnosis of a brain tumor is difficult in the initial stage of the disease, before the development of stagnant discs. The cause of cerebral and focal changes, imitating a tumor, can be an abscess of the brain, subdural hematoma, aneurysm. The possibility of a tumor is often likely to occur with epileptic disease and cerebrovascular disease.

Treatment. Decrease in intracranial pressure (lasix, dexamethasone, glycerol, mannitol) in the stage of examination of the patient. It is undesirable to prescribe potent sedatives and neuroleptics that can mask the deterioration of the patient's condition. The main treatment for brain tumors is surgical. In some cases with gliomas after surgery, X-ray therapy is performed.

The prognosis depends on the histological structure and localization of the tumor. The most effective surgical treatment of meningiomas and neurin. With malignant gliomas (glioblastoma) and metastatic tumors, the prognosis is poor.