neuro-onkology · clasification acta neuropathol. 2007 august; 114(2): 97–109. published online...
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Jaroslav Jeřábek
Neuro-onkology
Incidence 4.5-13/100 000• 80% supratentorial (1/2 metastic)
• Frequency: metastases, glioblastoma
• Childhood: max.primary (70% infratentorial (3/4 cerebellum, ¼ brainstem)
Clasification
Acta Neuropathol. 2007 August; 114(2): 97–109.
Published online 2007 July 6. doi: 10.1007/s00401-007-0243-4
PMCID: PMC1929165
The 2007 WHO Classification of Tumours of the Central Nervous System
David N. Louis,1 Hiroko Ohgaki,2 Otmar D. Wiestler,3 Webster K. Cavenee,4 Peter C. Burger,5 Anne Jouvet,6 Bernd W. Scheithauer,7 and Paul Kleihues8
Metastic tumors• CNS parenchymal - mamma, lung,
melanoma
• hypofyseal- lung, melanoma
• meningeal- lung, prostat, mamma
• skull - mamma, prostat, osteosarcoma
• Spine- lung, mamma, prostat, colorect.
Symptoms• Localising: ep, fatic, hemiparesis, visual
field defects
• Nonlocalising: headache, unsciousness, changes of personality, attention, memmory, vertigo, papilary edema
Be aware of tumor
• Headache- 60%
• Epilepsy- 30%
• Progression of focal signs- 20%
Progression of focal signs
Chiasma
Bitemporal hemianopsy
Hormonal changes
• Prolaktinom
• HGH – akromegaly
• ACTH – Cushing
• hypopituitarismus
Haemorhage in tumor = acute signs
Headache
• night, in the morning, worsened by Valsalva maneuver
• Change of type of chronic headache
• Persisting “aura”
psychologicalchanges
• personality
• memory
• organic psychsyndom
• pseudoneurasthenia
• behaviour - agressivity, passivity
Epileptic paroxysm
• CAUTION: secondarity
• MRI
• CAUTION: non-contrast CT
Neurologic signs
• Neurostatus can be normal
• Hydrocefalus- infratentorial tu
• Brainstem symptoms
• Foster-Kennedy: visual loss+ contralat. papiledema (meningeoma os.sphenoidale)
• Hemichorea: BG (astrocytoma, lymfoma)
• Everything
Spinal tumors
• Intramedular (ependymoma, asrocytoma): pain +, sensitivity-, sphincters, spasticity, pyramidal signs
• Intradural, extramedulary(meningeoma): pain + - +++(meta), radicular signs - paresis, pyramidalsigns
• Epidural (meta): pain +++, radikular sy
Neurosurgery
• Biopsy
• Localisation malignanacy
• Internal tumor decompression
• fMRI
Radiotherapy• Radiation
• Radiosurgery- gamma knife, X knife, Novalis robotic 6D system
• Postiaradiation necrosis
• antiedematous treatmen (steroids)
• myelopathy (radiation)
Chemoterapie
• Součást kombinované léčby
• Tumory NS většinou nepříliš sensitivní
• definovaná schémata
Conservative treatmentICH• Dexamethazon inj. a tabl.
• Mannitol
• Glycerin
• Arteficial hyperventilation
Antiepileptics
Psychotherapy, rehabilitation, etc
Outcome
• Type, lokalisation
• Glioblastoma - 12-15 m.
• Meningeoma - rarely reocurring
• Watch and wait (schwannomas)
Don´t forget !
• Headache- 60%
• Epileptic paroxysm- 30%
• Progression of focal signs - 20%
• Neuroradiology
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