BRAIN

AND SPINAL CORD TUMORS

Tumor
WHO
Age
Grade
NEUROEPITHELIAL TUMORS
Pilocytic
Grade I
<25 y.o.
Astrocytoma

AKA:
Cystic
cerebellar
astrocytoma
Juvenile
pilocytic
astrocytoma
Optic glioma (if on
optic nerve)
Hypothalamic
glioma

Locations

Radiology

Cerebellar
hemisphere
Optic nerve/chiasm
Hypothalamus

Discrete
appearing,
contrast
enhancing lesion with cystic, mural
nodule

Tumor DOES NOT

enhance on contrast

Diffuse Astrocytoma Grade II

AKA:
Low Grade Diffuse
Astrocytoma

Temporal lobe
Posterior frontal lobe
Anterior Parietal lobe

Glioblastoma

AKA:
Glioblastoma
Multiforme (GBM)

Grade IV

Oligodendrioglioma

Grade II or
III

Frontal lobes

Clinical
Presentation

significantly Seizures
Headache

Enhancing ring is cellular tumor

Non-enhancing center is cyst
Tumor cells present >15mm beyond
the ring
butterfly glioma

Calcifications are common

Seizures

Treatment

Others

Cerebellar PCA:

Maximal surgical excision

Optic glioma:
If optic nerve is spared excision
If chiasm is involved biopsy,
chemo or radiotherapy

Surgery: if at risk for progression

Radiation: inc progression free
survival
Chemotherapy, Observation

Fibrillary (MC cell type)

Major
cause
of
morbidity
is
DEDIFFERENTIATION to
more malignant grade

Surgery
Radiation
Chemotherapy

MC Primary
tumor
Most malignant

Surgery
Chemotherapy
Radiotherapy
for
transformation

brain

Histology: fried egg

cytoplasm and chicken
anaplastic wirevascularity

Choroid
Papilloma

Plexus Grade I

Children:
Supratentorial
Adults: Infratentorial

Medulloblastoma

Grade IV

Children

Cerebellar vermis in Cranial CT or MRI

the region of the Spinal MRI for drop mets.
apex of the roof of
th
the 4 ventricle

Ependymoma

Grade II

Floor of 4 ventricle

Cranial and Paraspinal Nerve Tumors

Schwannoma
Grade I
Middle
aged
and
early
adult
females

th

Craniospinal MRI

Inc. ICP:
Headache
N/V
Craniomegaly

Surgery

Headache
Surgery debulk
N/V
Radiotherapy
Ataxia
Irritability,
Lethargy and
Macrocrania

MC
malignant
PEDIATRIC brain tumor

Poor prognosis:
<3yo
Drop mets.
2
Tumor residual >1.5cm

Inc ICP:
Headache,
N/V, ataxia

Gross total removal

Radiotherapy

Hearing loss
Tinnitus
Dysequilibrium

Expectant mngmt
Radiation
Surgery
Chemotherapy

MC
Intracranial:
Vestibular Schwannoma

If bilateral, associated
with NF2

Superior vestibular Cranial MRI
nerve
at
the Pure tone audiogram
Obersteiner-Redlich

zone

Meninges
Meningioma

Grade I, II
or III

Arachnoid cap cells

Cranial CT or MRI with contrast

Cerebral angiogram
Spinal MRI for spinal angioma

Depends
location

nd

on Surgery
Radiotherapy
Depends on Simpson Grading

2
MC
primary
intracranial tumor

Lymphomas and Hemopoeitic Neoplasms
CNS Lymphoma

Germ Cell Tumors

Pineal
Region
Neoplasm

Tumors of the Sellar Region

Pituitary Tumor

Homogenously enhancing lesions in Mental status

central gray matter, corpus callosum, change
periventricular
Inc ICP
Generalized
seizures

Surgery for biopsy

Ghost
tumor:
Radiotherapy whole brain but disappears when given
lower dose
steroids
Methotrexate
CSF: elevated protein
and cell count

Children

Hydrocephalus
N/V
Parinauds
syndrome
Precocious
puberty

Surgery - biopsy

B-HCG:
Choriocarcinoma
AFP: endodermal sinus
tumor
PLAP: germinoma

Endocrine
disturbance
Mass effect
Pituitary
apoplexy

Prolactinoma Bromocriptine
GH secreting Ocreotide
Surgery
Radiotherapy

Adenohypophysis
(anterior pituitary)

Cranial MRI

Metastatic Tumors
Brain Metastasis

CT Scan

MC brain tumor seen

clinically (from the
lungs)
Hematogenous spread

Better prognosis:
Kernofsky score >70
<60 yo
No systemic mets
Controlled primary
Few # of mets
Female



Cancer pt with Surgery to reduce pain, stabilize Routes:
Aterial,
back pain that and preserve ambulation
Baxtons
plexus,
persists
in
Perinervous
recumbency
Radiotherapy

Motor
and
sensory
dysfunction


90%
completely
intradural

Spine Tumors

Spinal
epidural
metastases

Lung,
prostate,
lymphoma

Spinal Meningioma

82% thoracic

Spinal Schwanomma

40-70
yo
Females

Intradural
intramedullary

Grade I

Dorsal
rootlets

breast,
GI,

(sensory)

Males in Filum
rd
3 to
th
6
decade

Radicular

symptoms
(shooting pain
at dermatome
level)

Excision

Surgery
Stereotactic surgery
Whole brain RT
Chemotherapy

Slow growing benign

tumors

Rare recurrence
Most common glioma
of the lower cord,
conus and filum

#teammasters