c


„ A primary brain tumor is a

group (mass) of abnormal
cells that start In the brain.
„ A brain tumor is a localized
intracranial lesion that
occupies space within the
skull. Tumors usually grow
as a spherical mass, but
they can grow diffusely
and infiltrate tissue. The
effects of neoplasm occur
from the compression and
infiltration of tissue.
 "
"



„ Increased
intracranial pressure
(ICP) and cerebral
edema
„ Seizure activity and
focal neurologic
signs
„ Hydrocephalus
„ Altered pituitary
function
 


„ unknown
 


„ ë posure to
ionizing
radiation
„ Head injuries
„ Smoking
½




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 

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èthe most common type of brain
neoplasm
ÿ Astrocytomas
è are graded from 1 to 4, indicating
the degree of malignancy
è usually these tumors spread by
infiltrating into the surrounding
neural connective tissue and
therefore cannot be totally
removed without causing
considerable damage to vital
structures
ÿ V
odendro
a
è are more sensitive to
chemotherapy than astrocytomas

 

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„ are common benign
encapsulated tumors of
arachnoid cells on the
meninges
„ they are slowègrowing and
occur most often in middleè
aged adults
„ most often occur in areas
pro imal to the venous sinuses
„ manifestations depend on the
area involved and are the result
of compression rather than
invasion of brain tissue
„ standard treatment is surgery
with complete removal or
partial dissection

 

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„ tumor of the eight cranial nerve,
the cranial nerve most responsible
for hearing and balance.
„ it usually arises just within the
internal auditor meatus, where it
frequently e pands before filling
the cerebllopontine recess
„ an acoustic neuroma may grow
slowly and attain considerable size
before it is correctly diagnosed
„ the patient usually e periences:
è oss of hearing
èTinnitus
èëpisodes of vertigo
èStaggering gait

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¦





èa result of pressure on adjacent
structures or hormonal changes
(hyperfunction or hypofunction of the
pituitary)
ÿ ¦ressure effects of p
tu
tary
adenomas
è pressure from a pituitary adenoma
may be e erted on the optic nerves,
optic chiasm, or optic tracts or on the
hypothalamus or the third ventricle
when the tumor invades the cavernous
sinuses or e pands into the sphenoid
bone
è These pressure effects produce
headache, visual dysfunction,
hypothalamic disorders, increased ICP,
enlargement and erosion of the sella
turcica

 

ÿ Ôormona effects of p
tu
tary adenomas
è unctioning pituitary tumors can produce one or more hormones normally
produced by the anterior pituitary
è these hormones may cause prolactin secreting pituitary adenomas
(prolactinomas), growth hormone secreting pituitary adenomas that produce
acromegaly in adults, and adrenocorticotropic hormone (ACTH)èproducing pituitary
adenomas that result in Cushing disease
è adenomas that secrete thyroidèstimulating hormone or follicleèstimulating
hormone and luteinizing hormone occur infrequently, whereas adenomas that
produce both growth hormone and prolactin are relatively common
è emale patient whose pituitary gland is secreting e cessive quantities of prolactin
presents with amenorrhea or galactorrhea (e cessive or spontaneous flow of milk)
è Male patients with prolactinomas may present with impotence and
hypogonadism
è acromegaly, caused by e cess growth hormone, produces enlargement of the
hands and feet, distortion of the facial features, and pressure on peripheral nerves
(entrapment syndrome)
è clinical manifestation of Cushing disease include a form of obesity with
redistribution of fat to the facial, supraclavicular, and abdominal areas;
hypertension; purple striae and ecchymoses; osteoporosis; elevated blood glucose
levels; and emotional disorders

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„ masses composed largely of
abnormal blood vessels are found
either in or on the surface of the
brain
„ some persists throughout life
without causing symptoms; others
cause symptoms of a brain tumor
„ occasionally, the diagnosis is
suggested by the presence of
another angioma somewhere in
the head or by bruit (an abnormal
sound) audible over the skull
„ because the walls of the blood
vessels in angiomas are thin,
these patients are at risk for a
cerebral vascular accident (stroke)
 
 
½

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„ Increasing ICP
„ Headache
„ Vomiting
„ Visual disturbances
(papilledema)
„ Hemiparesis
„ Seizures
„ Mental status changes
  




„ ?otor cortex tumor
èProduces seizureèlike
movements localized on one
side of the body, called
Jacksonian seizures

„ Vcc
p
ta obe tumor

èProduces visual
manifestations: contra lateral
homonymous hemianopsia
(visual loss in half of the visual
field on the opposite side of
the tumor) and visual
hallucinations
 




„ erebe ar tumor
èCauses dizziness, an ata ic or
staggering gait with a tendency to
fall toward the side of the lesion,
marked muscle incoordination, and
nystagmus (involuntary rhythmic eye
movements) usually in the horizontal
direction
„ ronta obe tumor
èProduces personality disorders,
changes in emotional state and
behavior, and an uninterested
mental attitude
èthe patient often becomes
e tremely untidy and careless and
may use obscene language
 




„ erebe opont
ne an e tumor
èusually originates in the sheath of the
acoustic nerve and gives rise to a
characteristic sequence of symptoms
ètinnitus and vertigo appear first, soon
followed by progressive nerve
deafness (eight cranial never
dysfunction)
ènumbness and tingling of the face and
tongue occur (due to involvement of
the fifth cranial never)
èlater, weakness or paralysis of the
face develops (seventh cranial nerve
involvement)
èfinally, because the enlarging tumor
presses on the cerebellum,
abnormalities in motor functions may
be present
D ½

½
 D
 

„ omputed tomoraphy (
scan
ècan give specific information concerning the
number, size, and density of the lesions and
the e tent of secondary cerebral edema
ècan provide information about the
ventricular system

„ ?anet
c resonance
ma
n (?

èis the most helpful diagnostic tool for
detecting brain tumors, particularly smaller
lesions, and tumors in the brain stem and
pituitary region, where bone interferes with
CT

„ ¦os
tron em
ss
on tomoraphy (¦

èit is used to supplement MRI
èlow grade tumors are associated with
hypometabolism and highègrade tumors
show hypermetabolism
èthis information can be useful in treatment
decisions
D
 

„ omputer-ass
sted stereotact
c (three-
d
mens
ona
b
opsy
èused to diagnose deepèseated brain
tumors and to provide a basis for
treatment and prognosis
„ erebra an
oraphy
èprovides visualization of cerebral blood
vessels and can localize most cerebral
tumors
„  ectroencepha oram ()
ècan detect an abnormal brain wave in
regions occupied by a tumor and is used to
evaluate temporal lobe seizures and assist
in ruling out other disorders
„ yto o
c stud
es of the 
èmay be performed to detect malignant
cells because CNS tumors can shed cells
into the CS
 
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D





„ hemotherapy
„ ad
at
on herapy
è The cornerèstone of treatment of many brain
tumors, decreases the incidence of recurrence of
incompletely resected tumors
„ crachytherapy
èthe surgical implantation of radiation sources to
deliver high doses at a short distance
èhad promising results for primary malignancies
èit is used as an adjunct to conventional radiation
therapy or as a rescue measure for recurrent disease
„ ntravenous (
auto oous bone marrow transp ant
èis used in some patients who will receive
chemotherapy or radiation therapy because it has the
potential to ͞rescue͟ the patient from the bone
marrow to icity associated with high doses of
chemotherapy and radiation
èa fraction of the patient͛s bone marrow is aspirated,
usually from the iliac crest, and stored
èthe patient receives large doses of chemotherapy or
radiation therapy to destroy large number of
malignant cells
èthe marrow is then reinfused intravenously after
treatment is completed
 
D





„ ort
costero
ds
èmay be used before and after treatment
to reduce cerebral edema and promote a
smoother, more rapid recovery
„ ene-transfer therapy
èuses retroviral vectors to carry genes to
the tumor, reprogramming the tumor
tissue for susceptibility to treatment
„ ¦hotodynam
c therapy
èthis is a treatment of primary malignant
brain tumors that delivers a targeted
therapy while conserving healthy brain
tissue
è combines a drug (called a
photosensitizer or photosensitizing
agent) with a specific type of light to kill
cancer cells
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  





„ ransspheno
da m
crosur
ca remova
ètreatment for most pituitary adenomas
èwhereas the remainder of tumors that
cannot be removed completely are treated
by radiation
èan untreated brain tumor ultimately leads
to death, either from increasing ICP or from
the damage to brain tissue it causes
„ ran
otomy
èis used in patients with meningiomas,
acoustic neuromas, cystic astrocytomas of
the cerebellum, colloid cysts of the third
ventricle, congenital tumors such as dermoid
cyst, and some of the granulomas
èthe rationale for resection includes relieving
ICP, removing any necrotic tissue, and
reducing the bulk of the tumor, which
theoretically leaves behind fewer cells to
become resistant to radiation or
chemotherapy
  





„ ad
o
sotopes
èsuch as iodine 131 can also be
implanted directly into the tumor to
deliver high doses of radiation to the
tumor (brachytherapy) while
minimizing effects on surrounding
brain tissue
èthe use of the gamma knife to
perform radio surgery allows deep,
inaccessible tumors to be treated,
often in a single session
èprecise localization of the tumor is
accomplished using the stereotactic
approach and by minute
measurements and precise positioning
of the patient
èmultiple narrow beams then deliver a
very high dose of radiation
 
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„ he pat
ent w
th a
bra
n tumor may be
at an
ncreased r
sk
for asp
rat
on due to
cran
a nerve
dysfunct
on
[ Preoperatively, the
gag refle and ability
to swallow are
evaluated
  




„ n pat
ents w
th
d
m
n
shed a response
[ Teach the patient to
direct food and fluids
toward the unaffected
side
[ Having the patient sit
upright to eat
[ Offering a semisoft diet
[ Having suction readily
available
 




„ unct
on shou d be reassessed
postoperat
ve y because
chanes can occur
[ The nurse performs neurologic
checks
[ Monitors vital signs
[ Maintains a neurologic flow
chart
[ Spaces nursing interventions to
prevent rapid increase in ICP
[ Reorients the patient when
necessary to person, time and
place
  




„ ¦at
ents w
th chanes
n
con
t
on caused by the
es
on
[ requent reorientation and
the use of orienting devices
(personal possessions,
photographs, lists, clock)
[ Supervision of and
assistance with selfècare
[ Ongoing monitoring and
intervention for prevention
of injury
 




„ ¦at
ents w
th se
ures
[ Are carefully monitored and
protected from injury
[ Motor function is checked at
intervals because specific motor
deficits may occur, depending on
the tumor͛s location
[ Sensory disturbances are
assessed
[ Speech is evaluated
[ ëye movement and papillary size
and reaction may be affected by
cranial nerve involvement
ë