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Neural Tumors & Mixed Tumors Pituitary Adenoma
Medulloblastomas Anterior Pituitary (Adenohypophysis)
PNETS most common; arise from bipotential cells Microadenoma (<1cm) / Macro
(capable of differentiating into neurons or glial Functional (endocrine) / Nonfunctional (mass
cells) effect)
1st and 3rd decade
most common pediatric malignant tumor; usually Endocrine Dysfunction
midline & @ cerebellum Cushing’s disease ACTH secretion
S/S ICP Forbes-Albright syndrome PRL secretion
Histo: Tx: Dopamine
Densely packed small round cells w/ large Sx if persistent mass effect
nuclei & scant cytoplasm Acromegaly Growth hormone secretion
NOT encapsulated, frequently disseminated S/S
Tx: Visual field defects compression of optic
Surgical resection radiation tx chemotx chiasm
Panhypopituitarism compression of entire
Ganglioglioma gland
Mixed tumor (neurons & glial cells) Hemorrhage Pituitary apoplexy
First 3 decades Headache
Medial temporal lobe seizure Visual disturbance
Circumscribed masses that may contain cysts/ mental status
calcium endocrine disfunction
Mx: Transphenoidal Sx (through the nose)
Neural Crest Tumor
Multipotent
Hemangioblastoma
Miscellaneous tumors @ Posterior fossa
MENINGIOMA 20% Von Hippel-Lindau disease
From arachnoid cells (arachnoid matter) multisystem neoplastic d/o
From dura matter (grossly & MRI) “Dural-based also assoc w/:
tumors” Renal cell CA
Locations: Pheochromocytomas
Falx Retinal angiomas
Convexities (cerebral hemispheres) Appear as cystic w/ mural nodule (enhancing tumor
Sphenoid wing @ cyst wall)
Less common: Mx: En bloc resection of mural nodule alone is
Foramen magnum sufficient
Olfactory groove Sx resection is curative for sporadic (non-VHL)
Inside Lateral ventricle tumors
Mostly slow growing, encapsulated, benign Patho:
If malignant invade adjacent bone or into Thin walled vascular channels (internal
cortex debulking may be bloody)
Previous cranial irradiation increases incidence
10% - multiple Lymphoma
Primarily @ CNS or 2ndary to systemic disease
Vestibular Schwannoma (Acoustic Neuroma) Incidence:
Arise from the superior half of the vestibular Transplant px
portion of vestibulocochlear nerve (CN 8) AIDS
S/S: S/S:
Progressive hearing loss Mental status changes
Tinnitus Headache ICP
Balance difficulty CN palsy lymphomatous meningitis
Large tumors: (~carcinomatous meningitis)
brainstem compression Hyperdense on CT (dense cellularity)
obstructive hydrocephalus Sx excision: little role
If bilateral NF 2 Tx: steroids, whole brain radiation, chemotherapy
Chromosome 22 mutation (intrathecal methotrexate)
incidence of spinal & cranial meningiomas &
gliomas
Tx: microsurgical resection or gamma knife
Main complication: Damage to CN 7 – Facial Nerve
(because it runs through the internal auditory canal
w/ CN 8) this risk with tumor diameter
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Embryologic Tumors BRAIN ABSCESS
Failure to involute or differentiate properly Encapsulated infection w/in brain parenchyma
Spread hematogenously in px w/
Craniopharyngioma endocarditis
Benign, cystic lesions in children intracardiac
2nd peak of occurrence (50 y/o) intrapulmonary RL shunts
All pediatric & 50% of adult craniopharyngiomas migration from sinuses or ear
calcify direct seeding by penetrating trauma
S/S: Disorganized cerebritis preceedes abscess formation
Compression of adjacent structures (optic S/S:
chiasm) Headache
Pituitary/ hypothalamic dysfunction or Nausea
hydrocephalus may develop Lethargy
Sx: FND (hemiparesis)
Excision is easier in children (soft & suckable Extremis (???) if abscess ruptures into ventricular
tumor) system
Adult tumors (firm & adherent to adjacent vital CT/MRI: Well demarcated, ring enhancing, thin walled
structures) lesions w/ assoc edema & mass effect
Complications from Sx: Blood & CSF cultures: rarely give definitive diagnosis
Visual loss
Pituitary endocrine hypofunction
Diabetes insipidus
Cognitive impairment (basal frontal injury)
Epidermoid
Cystic lesions w/ stratified squamous epithelial
walls from trapped ectodermal cell rests
Grow slow & linearly by desquamation into cyst
cavity
Contain:
Keratin
Cholesterol
Cellular debris
CPA Angle
Mollaret’s Meningitis recurrent bouts of aseptic
meningitis due to release of irritating cyst contents
into subarachnoid space
Dermoid
Less common than epidermods
Contain hair follicles, sebaceous glands, squamous
epithelium
Midline structures
Bacterial meningitis if associated with skin sinus
tract
Teratoma
Midline (often @ pineal region area behind 3rd
ventricle, above midbrain & cerebellum)
Contain elements from all 3 germ layers: endo,
meso & ectoderm
Contain skin, cartilage, GI glands, teeth
If w/ more pirimitive structures = more malignant
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CEREBROVASCULAR DISEASE - Schwartz Majority enter: Anterior carotid circulation
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Tx:
Microsurgical excision
Endovascular glue embolization
Reduces flow through AVM
Usually considered as adjunctive tx
Steriotactic radiosurgery
Lesions < 3 cm
2 yr time lag (AVM may bleed in the
interval)
Les
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