Brain tumors — the intra cranial new growths including both tumoral defeats of cerebral fabrics, and nerves, covers, vessels, endocrine structures of a brain. Are shown by the focal symptomatology depending from defeat topics and all-brain symptoms. The diagnostic algorithm includes survey of the neurologist and ophthalmologist, Ekho-EG, brain EEG, KT and MRT, the MR-angiography and so forth. The most optimum is the surgical treatment according to indications added himio-and radiotheraphy. At its impossibility palliative treatment is carried out.
Tumors of a brain make up to 6% of all new growths in a human body. Frequency of their occurrence fluctuates from 10 to 15 cases on 100 thousand people. Traditionally carry all intrakranialny new growths to cerebral tumors — tumors of cerebral fabric and covers, formations of cranial nerves, vascular tumors, new growths of lymphatic fabric and ferruterous structures (a hypophysis and shishkovidny gland). In this regard tumors of a brain divide on intracerebral and extra brain. Carry new growths of cerebral covers and their vascular textures to the last.
Tumors of a brain can develop at any age and even to have congenital character. However among children incidence is lower, does not exceed 2,4 cases on 100 thousand children's population. Cerebral new growths can be primary, initially originating in brain tissues, and secondary, metastatic, caused by distribution of tumor cells owing to gemato-or a limfogenny dissemination. Secondary tumoral defeats meet at 5-10 times more often than primary new growths. Among the last the share of malignant tumors makes not less than 60%.
Distinctive feature of cerebral structures is their arrangement in limited intrakranialny space. For this reason any volume formation of intra cranial localization in a varying degree leads to a sdavleniye of brain fabrics and increase in intrakranialny pressure. Thus, even brain tumors benign in character at achievement of a certain size have a malignant current and can lead to a lethal outcome. Taking into account it special relevance for experts in the field of neurology and neurosurgery is gained by a problem of early diagnostics and adequate terms of surgical treatment of cerebral tumors.
Brain tumor reasons
Emergence of cerebral new growths, as well as tumoral processes of other localization, connect with influence of radiation, various toxic substances, essential environmental pollution. At children the frequency of congenital (embryonic) tumors is high, as one of the reasons of which violation of development of cerebral fabrics in the pre-natal period can act. The craniocereberal trauma can serve as a provocative factor and intensify latentno the proceeding tumoral process.
In some cases tumors of a brain develop against the background of performing radiation therapy to patients with other diseases. The risk of emergence of a cerebral tumor increases when passing immunosupressivny therapy, and also at other groups of immunokomprometirovanny persons (for example, at HIV infection and neuroaIDS). Predisposition to emergence of cerebral new growths is noted at separate hereditary diseases: Gippelya-Lindau's disease, tuberozny sclerosis, fakomatoza, neurofibromatosis.
Among primary cerebral new growths neyroektodermalny tumors which classify on a tumor of astrotsitarny genesis (an astrotsitom, an astroblastom), oligodendroglialny genesis (an oligodendrogliom, an oligoastrogliom), ependimarny genesis (an ependimom, papilloma of a horioidny texture), tumors of an epifiz (a pineotsitom, a pineoblastom), neyronalny (a ganglioneyroblastoma, a gangliotsitoma), the embryonic and low-differentiated tumors prevail (a medulloblastoma, a spongioblastoma, a glioblastoma). Also allocate hypophysis new growths (adenoma), tumors of craniocereberal nerves (neurofibroma, a nevrinoma), formations of cerebral covers (a meningiom, ksantomatozny new growths, melanotichny tumors), cerebral lymphoma, vascular tumors (an angioretikuloma, a gemangioblastoma). Intracerebral cerebral tumors classify by localization on sub - and supratentorialny, polusharny, tumors of middle structures and a tumor of the basis of a brain.
Metastatic tumors of a brain are diagnosed in 10-30% of cases of cancer defeat of various bodies. To 60% of secondary cerebral tumors have multiple character. As the most frequent sources of metastasises at men lung cancer, a colorectal cancer, kidney cancer act, women have a breast cancer, lung cancer, a colorectal cancer and a melanoma. About 85% of metastasises are the share of intracerebral tumors of hemispheres of a brain. In a back cranial pole metastasises of cancer of body of a uterus, a prostate cancer and malignant tumors of a GIT are usually localized.
Brain tumor symptoms
Earlier manifestation of cerebral tumoral process is the focal symptomatology. It can have the following mechanisms of development: chemical and physical impact on surrounding cerebral fabrics, damage of a wall of a brain vessel with hemorrhage, vascular occlusion a metastatic embol, hemorrhage in a metastasis, a vessel compression with development of ischemia, a compression of backs or trunks of craniocereberal nerves. And in the beginning symptoms of local irritation of a certain cerebral site take place, and then there is a loss of its function (neurologic deficiency).
In process of growth of a tumor the compression, hypostasis and ischemia extend to the fabrics, next to an affected area, in the beginning, and then to more remote structures, causing emergence according to symptoms "in the neighbourhood" and "on a distance". The all-brain symptomatology caused by intra cranial hypertensia and hypostasis of a brain develops later. At the considerable volume of a cerebral tumor the mass effect (shift of the main brain structures) with development of a dislocation syndrome — a vklineniye of a cerebellum and a medulla in an occipital opening is possible.
- The headache of local character can be an early symptom of a tumor. It arises owing to irritation of the receptors which are localized in cranial nerves, venous sine, walls of obolochechny vessels. The diffusion tsefalgiya is noted in 90% of cases of subtentorialny new growths and in 77% of cases of supratentorialny tumoral processes. Has the nature of the deep, rather intensive and holding apart pain, often pristupoobrazny.
- Vomiting usually acts as an all-brain symptom. Its main feature — lack of communication with meal. At a tumor of a cerebellum or the IV ventricle it is connected with direct impact on the emetic center and can be primary focal manifestation.
- System dizziness can proceed in the form of feeling of fall, rotation of own body or surrounding objects. During a demonstration of clinical manifestations dizziness is considered as the focal symptom indicating defeat by a tumor of a vestibulokokhlearny nerve, the bridge, a cerebellum or the IV ventricle.
- Motive violations (pyramidal frustration) happen as primary tumoral symptomatology at 62% of patients. In other cases they arise later in connection with growth and spread of a tumor. The accruing anizorefleksiya of tendinous reflexes from extremities belongs to the earliest manifestations of pyramidal insufficiency. Then there is a muscular weakness (paresis) which is followed by a spastichnost at the expense of a muscular hyper tone.
- Touch violations generally accompany pyramidal insufficiency. Are clinically shown approximately at a quarter of patients, in other cases come to light only at neurologic survey. As primary focal symptom frustration of musculoarticulate feeling can be considered.
- The convulsive syndrome is more characteristic of supratentorialny new growths. At 37% of patients with cerebral tumors of an epipristupa act as a manifest clinical symptom. Emergence of absans or generalized toniko-clonic epipristup is more typical for tumors of median localization; paroxysms as dzheksonovsky epilepsy — for the new growths located near brain bark. The nature of aura of an epipristup often helps to establish to a defeat topic. In process of growth of a new growth generalized epipristupa are transformed to partial. When progressing intrakranialny hypertensia decrease in an epiaktivnost is, as a rule, observed.
- Frustration of the mental sphere during a demonstration meets in 15-20% of cases of cerebral tumors, mainly at their arrangement in a frontal lobe. Lack of initiative, untidiness and apathy are typical for tumors of a pole of a frontal lobe. The Eyforichnost, complacency, causeless cheerfulness indicate defeat of basis of a frontal lobe. In such cases progressing of tumoral process is followed by increase of aggression, malignancy, negativism. Visual hallucinations are characteristic of the new growths located on a joint a temporal and frontal lobe. Mental disorders in the form of the progressing memory impairment, violations of thinking and attention act as all-brain symptoms as are caused by the growing intrakranialny hypertensia, tumoral intoxication, damage of associative paths.
- Stagnant disks of optic nerves are diagnosed for a half of patients more often in later stages, however at children can serve as a debut symptom of a tumor. Due to the increased intra cranial pressure the passing zatumanivaniye of sight or "front sight" before eyes can appear. When progressing a tumor the accruing deterioration in sight connected with an atrophy of optic nerves is noted.
- Changes of fields of vision arise at defeat of a hiazma and visual paths. In the first case the geteronimny gemianopsiya (loss of heteronymic half of visual fields), in the second — gomonimny is observed (loss in fields of vision of both right or both left half).
- Other symptoms can include relative deafness, sensomotorny aphasia, a cerebellar ataxy, glazodvigatelny frustration, olfactory, acoustical and flavoring hallucinations, vegetative dysfunction. At localization of a tumor of a brain in a hypothalamus or a hypophysis there are hormonal frustration.
Primary inspection of the patient includes assessment of the neurologic status, survey of the ophthalmologist, carrying out an echo encephalography, EEG. At a research of the neurologic status the neurologist pays special attention to the focal symptomatology allowing to establish the topichesky diagnosis. Ophthalmologic researches include visual acuity check, an oftalmoskopiya and definition of fields of vision (perhaps, by means of computer perimetry). Ekho-EG can register the expansion of side ventricles testifying to intra cranial hypertensia and shift middle the M-echo (at big supratentorialny new growths with the shift of cerebral fabrics). On EEG existence of an epiaktivnost of certain sites of a brain is displayed. According to indications consultation of an otonevrolog can be appointed.
Suspicion on volume formation of a brain is the unambiguous indication to carrying out a computer or magnetic and resonant tomography. KT of a brain allows to visualize tumoral education, to differentiate it from local hypostasis of cerebral fabrics, to establish its size, to reveal a cystous part of a tumor (in the presence of that), kaltsifikata, a necrosis zone, hemorrhage in a metastasis or the fabrics surrounding a tumor, existence of mass effect. MRT of a brain supplements KT, allows to define more precisely distribution of tumoral process, to estimate an involvement into it of boundary fabrics. MRT is more productive in diagnostics of the new growths which are not accumulating contrast (for example, some gliomas of a brain), but concedes to KT if necessary to visualize bone and destructive changes and kaltsifikata, to differentiate a tumor from area of perifokalny hypostasis.
Besides standard MRT in diagnosis of a tumor of a brain MRT of vessels of a brain (a new growth vaskulyarization research), functional MRT (mapping of speech and motor zones), MR-spectroscopy (the analysis of metabolic deviations), MR-termografiya (control of thermodestruction of a tumor) can be applied. PET of a brain gives the chance to define brain tumor zlokachestvennost degree, to reveal a tumoral recurrence, to map the main functional zones. OFEKT with use of radiopharmaceuticals, tropny to cerebral tumors allows to diagnose multifocal defeats, to estimate a zlokachestvennost and degree of a vaskulyarization of a new growth.
The stereotaksichesky biopsy of a tumor of a brain is in some cases used. At surgical treatment the intake of tumoral fabrics for a histologic research is carried out intraoperatsionno. The histology allows to verify precisely a new growth and to establish the level of a differentiation of its cages, so and zlokachestvennost degree.
Treatment of a tumor of a brain
Conservative therapy of a tumor of a brain is performed for the purpose of decrease in its pressure upon cerebral fabrics, reduction of the available symptoms, improvement of quality of life of the patient. It can include anesthetics (ketoprofen, morphine), antiemetic pharmaceuticals (), sedative and psychotropic drugs. For decrease in puffiness of a brain appoint glucocorticosteroids. It is necessary to understand that conservative therapy does not eliminate the prime cause of a disease and can render only the temporary facilitating effect.
The most effective is surgical removal of a cerebral tumor. Technology of operation and access are defined by location, the sizes, a look and prevalence of a tumor. Application of surgical microscopy allows to make more radical removal of a new growth and to minimize traumatizing healthy fabrics. Concerning tumors of the small size the stereotaksichesky radio surgery is possible. Application technicians Kibernozh and the Gamma Knife is admissible at cerebral educations with a diameter up to 3 cm. At the expressed hydrocephaly the shunting operation (external ventrikulyarny drainage, ventrikuloperitonealny shunting) can be performed.
Beam and chemotherapy can supplement surgical intervention or be a palliative way of treatment. In the postoperative period radiation therapy is appointed if the histology of fabrics of a tumor found atipiya signs. The chemotherapy is carried out by the cytostatics which are picked up taking into account histologic type of a tumor and individual sensitivity.
Forecast and prevention
Predictively benign tumors of a brain of the small sizes and localization, available to surgical removal, are favorable. However many of them are inclined to recur that can demand repeated operation, and each surgical intervention on a brain is accompanied by the travmatization of its fabrics involving resistant neurologic deficiency. Tumors of the malignant nature, remote localization, the big sizes and metastatic character have the adverse forecast as cannot be considerably removed. The forecast also depends on age of the patient and the general condition of its organism. Advanced age and existence of the accompanying pathology (heart failure, HPN, diabetes, etc.) complicates implementation of surgical treatment and worsens its results.
Primary prevention of cerebral tumors consists in an exception of onkogenny influences of the external environment, early identification and radical treatment of malignant new growths of other bodies for the prevention of their metastasis. Prevention of a recurrence includes an exception of insolation, injuries of the head, reception of the biogenous stimulating medicines.