颅脑肿瘤的诊断和治疗英文培训课件.ppt

DiagnosisandTreatmentofBrainTumors BrainTumors Abraintumorisamassofunnecessary andabnormal cellsgrowinginthebrain Tumorsmaybebenign malignant arisefromwithinthebrain itscoverings ormetastasizefromanotherlocationinthebody NeurologicDiagnosis Whereisit SignsandSymptomsWhatisit Tempo TypesofTumors BenignMeningeal coveringofbrainNerveliningPituitaryBone CartilageMalignantPrimaryCNSMetastatic Incidence 186 000diagnosedin2002inUSA36 400primary 12 73 100 000 150 000metastatic 10 15 ofcancer Prevalence primary benign 100 100 000malignant 30 100 000 Statistics Secondmostcommonmalignancyofchildhood mostcommonsolidtumorSecondleadingcauseofcancerrelateddeathsinmalesage20 40Fifthleadingcauseofcancerrelateddeathsinwomenage20 40 CerebrumandCerebellum CranialNerves Base Generalizedsymptomsandsign Symptomsofincreasedintracrainalpressure mechanism IncreasedIntracranialPressure HeadacheHeadachesareacommoninitialsymptom Typical braintumorheadaches areoftendescribedasworseinthemorning withimprovementgraduallyduringtheday Theymayrousethepersonfromsleep Sometimes uponawakening thepersonvomitsthenfeelsbetter Theseheadachesmayworsenwithcoughing exercise orwithachangeinpositionsuchasbendingorkneeling Theyalsodonottypicallyrespondtotheusualheadacheremedies Nausea Vomiting Papilledema LethargyMentaland orPersonalityChangesThesecanrangefromproblemswithmemory especiallyshort termmemory speech communicationand orconcentrationchangestosevereintellectualproblemsandconfusion Changesinbehavior temperamentandpersonalitymayalsooccur dependingwherethetumorislocated Thesechangescanbecausedbythetumoritself byincreasedpressurewithintheskullcausedbythepresenceofthetumor orbyinvolvementofthepartsofthebrainthatcontrolpersonality DoublevisionSeizureSeizuresareacommonsymptomofabraintumor Seizuresarecausedbyadisruptioninthenormalflowofelectricityinthebrain Thosesuddenburstsofelectricitymaycauseconvulsions unusualsensations andlossofconsciousness Focalseizures suchasmuscletwitchingorjerkingofanarmorleg abnormalsmellsortastes problemswithspeechornumbnessandtingling mayalsooccur Focalsymptomsandsign局灶症状和体征 areduetoatumor seffectonspecificbrainstructures areusefultoindentifythelocationofbraintumor 1BrainStem theMidbrain Pons Medullamuscleweaknessdroopingeyeliddifficultyinswallowingdoublevision Theposteriorfossacontainsthefourthventricle cerebellumandbrainstem aclumsy uncoordinatedwalk swaying andstaggeringmightoccurdizziness tremors aswellasdifficultywithspeech arealsofrequentsymptoms Example ependynomas室管膜瘤P139 mostoftenoccurinchildrenandadolescent thefourthventricleisthemostcommonsiteslow growingbut脑积水areoftenoccured Example medulloblastomas髓母细胞瘤P139 IsthemostcommanbraintumorofchildhoodIsasmall cellneuroectodermaltumorofthecerebellumArehighlymalignant haveapropensitytoseedthoughouttheCSFArehighlyradiosensitive CerebellopontineAngletheearliestsymptomofatumorisringingorbuzzingintheear asatumorgrows deafness lossoffacialsensationand orfacialweaknesscanoccurothersymptomsaresimilartothoseofabrainstemtumor Example AcousticneuromaP141 Thisbenigntumororiginatefromtheeighthnerves usuallygrowslowlyandcantakeyearstodevelophearinglossandaringing tinnitus intheaffectedearvertigoandbalancedifficultiesIfuntreated itcanpressagainstothernervesintheregionandcauseothersymptoms Example epidermiodcyst表皮样囊肿P142 Thisbenigntumorbelongstocongenitaltumor OftenoccurinthecerebellopontineangelandthebasalcisternsThecapsuleisfrequentlyadherenttoadjacentcranialnervesandvascularstructureMRIstudiesareveryuseful FrontalLobethefrontallobeocontrolsvoluntarymovement usuallyontheoppositesideofthebody thefrontallobeofthedominanthemispherecontrolslanguageandwriting one sidedparalysis p r lisis seizures short termmemoryloss personalityormentalchanges Example oligodendrogliomas少突胶质细胞瘤P138 OccurofteninthefrontallobeAreassociatedwithalonghistoryofseizuresManyhavemineralization whichisvisibleonCT Low grade 5TemporalLobethetemporallobeisinvolvedintheunderstandingofsoundsandspokenwords aswellasemotionandmemory seizuresarethemostcommonsymptomofatumorinthislocation theabilitytorecognizesoundsorthesourceofsoundsmaybeaffected visioncanbeimpaired Example Glioblastoma胶质母细胞瘤P139 23 ofprimarybraintumorsmostcommonage45 64OfteninvasionmanylobesGradeIII IIIorIV IVMalignantastrocytoma rapidgrowthInvasive OccipitalLobetheoccipitallobeisinvolvedintheunderstandingofvisualimagesandthemeaningofwrittenword blindnessinonedirectionorothervisualdisturbances andseizuresarecommonsymptoms PituitaryregionHeadache occasionallywithnauseaandvomiting EndocrinedisturbancesusuallymanifestmoreprominentlyVisualdeficitsarecausedbycompressionoftheopticchiasmLargetumorscancausepsychiatricsymptoms memoryloss apathy incontinence depression andhypersomnia Example pituitarytumors垂体瘤P140 Theincidenceinautopsystudiesisgreaterthan20 mostarebenign mostcommoninage20 34Arecalssifiedasendocrinesecretingornon secretingprolactingrowthhormone acromegaly orgigantism ACTH cushing sdisease Arealsodividedbysizeintomicro 1cm Transsphenoidalapproachortransseptalincison Example craniopharyngioma颅咽管瘤P141 Accountforabout5 ofintracranialtumors themajorityinvolceboththesellaandthesupersellargrgions Visualdeficitsarecausedbycompressionoftheopticchiasmfromsuprasellartumorgrowth Endocrinedisturbancesusuallymanifestmoreprominentlyinchildren Ninety threepercentofchildrenexperiencegrowthfailure shortstature OnCT theadamantinomatousformmayshowcalcification Thegoaloftreatmentifcompletesurgicalresection butdifficulttoachieve XinshijiSquareofjining Yunheofjining astrocytomas星形细胞瘤P138 Astrocytomasmakeup60 ofbraintumors Thereare7 10casesper100 000populationdiscoveredperyear GradeIastrocytomas pilocyticAstrocytomas areseeninthecerebellum brainstemandopticnervesofchildren GradeIIastrocytomasareseeninthecerebralhemispheresof20 40yearoldindividualsandhighgradeastrocytomaswhicharemostmalignantintheircourseareseeninpatientsintheir50 sand60 s Astrocytomasactasprogressivemasslesionsofthebrainparenchymacausingprogressivelossoffunctionintheareasinvaded InvasionofthemotortractcauseshemiparesisInvasionofthespeechareascauseaphasiaetc Ifthecerebralcortexisinvolvedtheremaybeseizures Cerebrallesionsalsoleadtoincreasedintracranialpressurebytheirmasseffect Meningiomas脑膜瘤P140 25 7 ofprimarybraintumorsMostcommontumorinages 35 4475andolderHemisphericHeadache seizure focalneurologicdeficitSkullbaseCranialnerveinvolvement Meningioma minind i um sickleofcerebrum Meningioma sphenoid sf n d Meningioma tuburculum Diagnostictestsofbraintumors MostpatientsareimagedusingMRIasthest