CNS Neoplasms

Neoplasm definition

New abnormal growth of tissue (tumor)

CNS neoplasm definition

Tumors occurring in brain or spinal cord tissue

Paraneoplastic syndrome

Systemic effects caused by cancer via hormonal/immune mechanisms rather than direct invasion

Example of paraneoplastic syndrome

Lung cancer causing abnormal calcium regulation

Primary vs secondary tumor

Primary originates in CNS; secondary (metastatic) originates elsewhere and spreads

Common sources of CNS metastases

Lung breast GI melanoma kidney

Benign tumor characteristics

Slow growing non-invasive space occupying

Malignant tumor characteristics

Fast growing invasive infiltrative angiogenic

Histologic grading criteria

Nuclear atypia mitoses endothelial proliferation necrosis

Gliomas percentage of CNS tumors

30–40% of all primary brain tumors

Gliomas origin

Glial support cells

Glioma types

Astrocytoma oligodendroglioma ependymoma

Glioma gender ratio

3:2 male to female

Glioma peak age adults

45–55 years

Glioma peak age children

2–10 years

Low grade gliomas

Grade I–II slow growing better prognosis

High grade gliomas

Grade III–IV aggressive poor prognosis

Astrocytoma prevalence in children

~47% of pediatric brain tumors

Low-grade astrocytoma prognosis

Excellent with resection near 100% 10-year survival

Glioblastoma multiforme (GBM)

Highly malignant fast growing infiltrative astrocytoma

GBM prognosis

Poor ~40% 1-year survival <7% 5-year survival

Oligodendroglioma characteristics

Slow growing calcified may bleed mimic stroke

Oligodendroglioma prognosis

Good with treatment but recurrence common

Ependymoma location

Ventricles and posterior fossa

Ependymoma population

More common in children

Medulloblastoma characteristics

Fast growing malignant pediatric tumor

Medulloblastoma prognosis

Improving survival rates

Meningioma characteristics

Benign slow growing well encapsulated

Meningioma population

More common in women

Meningioma complication

Hyperostosis (skull thickening)

Pituitary adenoma symptoms

Hormonal imbalance visual field deficits

Neurinoma origin

Schwann cells

Acoustic neuroma effect

Hearing loss especially after resection

Primary brain tumor pathophysiology

Compression edema increased ICP CSF obstruction

Compensation in brain tumors

Decrease in blood CSF and tissue volume initially masks symptoms

Common CNS tumor symptom

Headache worse in morning

Headache mechanism

Increased intracranial pressure

ICP symptoms

Nausea vomiting papilledema

Papilledema prevalence

70–75%

Seizure prevalence in brain tumors

20–50% early up to 70% late

Cranial nerve VI compression sign

Lateral diplopia

MRI role in CNS tumors

Most informative diagnostic tool

CT scan use

Detects calcification or large tumors

Definitive diagnosis

Biopsy

Primary brain tumor treatment

Surgery radiation chemotherapy immunotherapy

Surgical debulking

Partial tumor removal to reduce mass effect

Common chemo drugs for CNS tumors

Carmustine lomustine vincristine temozolomide

Steroid use in CNS tumors

Reduce edema

Mannitol use

Reduce intracranial pressure

Anticonvulsant example

Phenytoin

Post-op precautions brain tumor

Avoid Valsalva no coughing sneezing or nose blowing

Positioning after brain surgery

Head elevated neck neutral

Avoid after brain surgery

Excess hip flexion pressure on bone flap

Intraspinal tumors prevalence

1/6 as common as brain tumors

Most common spinal tumor type

Schwannoma/neurinoma

Spinal tumor classification

Extradural extramedullary intradural extramedullary intradural intramedullary

Extradural extramedullary tumors

Usually metastatic

Intradural extramedullary tumors

Schwannomas meningiomas

Intradural intramedullary tumors

Gliomas

Extramedullary spinal tumor pain

Sharp radicular pain worse with coughing

Intramedullary spinal tumor pain

Diffuse burning poorly localized

Spinal tumor neuro signs

LMN at level UMN below

Classic spinal tumor symptom

Worse pain at night or recumbency

Red flag for spinal tumor

Back pain not relieved by PT

Spinal tumor diagnosis

MRI neuro exam imaging

Spinal tumor treatment

Surgical excision possible radiation

Brain metastases prevalence

~20% of intracranial tumors

Spinal metastases prevalence

~55% of spinal tumors

Most common primary source for CNS metastases

Lung cancer

Metastatic spread route

Arterial blood system

Brain metastases progression

Rapid symptom onset

Brain metastases prognosis

Poor

Spinal metastases hallmark symptom

Back pain (95% of cases)

Most common spinal metastasis location

Thoracic spine

Spinal metastasis progression

Weakness sensory loss bowel bladder dysfunction

Spinal metastasis treatment

Radiation chemotherapy steroids

Ambulatory prognosis after radiation

80% remain ambulatory if initially ambulatory

Recovery if non-ambulatory

~30% regain walking

Lhermitte’s sign

Cervical cord electric shock sensation with neck flexion

Late radiation complication

Chronic progressive myelopathy