Tumors of the central nervous system — various new growths back and a brain, their covers, likvorny ways, vessels. Symptoms of a tumor of TsNS have very variable character and manifestations in the neighbourhood and remote are subdivided on focal (neurologic deficiency), all-brain. In diagnostics, except neurologic survey, use radiological, electrophysiological, ultrasonic methods and a likvorny puncture. However more exact verification of the diagnosis is reached according to MPT or KT, the histologic analysis of a tumor. Concerning TsNS tumors the most effectively expeditious treatment. Use himio-and radiotheraphy as additional or palliative treatment is possible.
According to various data of a tumor of TsNS meet frequency of 2-6 cases at 100 thousand persons. From them about 88% are the share of cerebral tumors and only 12% on spinal. Incidences of the person of young age are most subject. The structure of children's oncology of a tumor of TsNS occupies 20%, and 95% from them are the share of brain tumors. The last years are characterized by a tendency to increase in incidence among aged people.
TsNS new growths not absolutely keep within the standard interpretation of a concept about high quality of tumors. The limited space of the vertebral channel and a cavity of a cranium cause the squeezing influence of tumors of this localization, is not dependent on degree of their zlokachestvennost, on back and a brain. Thus, in process of growth even benign tumors lead to development of the hardest neurologic deficiency and death of the patient.
Today the factors initiating tumoral transformation of cages remain a studying subject. Onkogenny action of radioactive radiation, some infectious agents (a virus of herpes, VPCh, separate types of adenoviruses), chemical compounds is known. Influence of dizontogenetichesky aspects of developing of tumors is studied. Existence of hereditary syndromes of tumoral defeat of TsNS testifies to a genetic determinant. For example, neurofibromatosis of Recklinghausen, tuberozny sclerosis, Gippelya-Lindau's disease, Gorlin-Golts's syndrome, Tyurko's syndrome.
Craniocereberal injuries, vertebral and spinal injuries, viral infections, professional harm, hormonal shifts are considered as the factors provoking or accelerating tumoral growth. A number of researches it was confirmed that usual electromagnetic waves, including going from computers and mobile phones do not belong to above-mentioned triggers. The increased occurrence of a tumor of TsNS at children with a congenital immunodeficiency, Louis Bar syndrome is noted.
Classification of tumors of TsNS
According to gistiogenezy in neurology and neurooncology allocate 7 groups of tumors. The most extensive of them is made by neyroektodermalny tumors: gliomas (good-quality and dedifferentiation astrotsitoma, oligodendroglioma, ependimoma, glioblastoma), medulloblastoma, pinealoma and pineoblastoma, horioidpapilloma, nevrinoma, ganglioznokletochny tumors (gangliotsitoma, ganglionevroma, ganglioglioma, ganglioneyroblastoma). Treat mesenchymal tumors of TsNS: meningioma, meningialny sarcoma, intracerebral sarcoma, gemangioblastoma, neurofibroma, angioma, lipoma.
Separate type of new growths of TsNS are hypophysis adenomas. The fourth group is made by tumors of rudiments of the hypophysial course — kraniofaringioma. The fifth — geterotopichesky ektodermalny new growths (holesteatoma, dermoidny cysts). The sixth group — TsNS teratoma — meet extremely seldom. Metastatic tumors of TsNS act as the last group. Lung cancer, a horionkartsinoma, a breast cancer, kidney and cellular cancer, a gipernefroma, a gepatotsellyulyarny carcinoma, stomach cancer, a melanoma, cancer of a thyroid gland, malignant tumors of adrenal glands, etc. is capable to give metastasises in TsNS.
According to the WHO classification allocate 4 degrees of a zlokachestvennost of a tumor of TsNS. The I degree corresponds to benign tumors. The I-II degrees belong to the low class of a zlokachestvennost (Low grade), the III-IV degree — to high (High grade).
TsNS tumor symptoms
Division of symptomatology of tumoral process of TsNS into the all-brain, focal, remote symptoms and symptoms according to the neighbourhood is standard.
All-brain manifestations are characteristic of cerebral and kraniospinalny tumors. They are caused by the violation of a likvorotsirkulyation and hydrocephaly, hypostasis of brain fabric, vascular disorders arising in the investigation of a sdavleniye of arteries and veins, disorder of cortical and subcrustal communications. The tsefalgiya (headache) acts as the leading all-brain symptom. It has holding apart, periodic in the beginning, then constant, character. Often is followed by nausea. At peak of a tsefalgiya quite often there is vomiting. Disorder of higher nervous activity is shown by absent-mindedness, block, forgetfulness. The irritation of brain covers can lead to emergence of the symptoms typical for their inflammation — meningitis. Emergence of epipristup is possible.
Focal symptoms are connected with defeat of brain fabric in the place of localization of a new growth. On them it is possible to judge the location of a tumor of TsNS presumably. Focal symptoms represent so-called "neurologic deficiency", i.e. decrease or lack of a certain motive or sensitive function on a separate part of the body. Paresis and paralyzes, pelvic violations, a gipesteziya, frustration of a muscular tone, violation of a statics and dynamics of the motive act, symptoms of dysfunction of craniocereberal nerves, a dizartriya, the violations of sight and hearing which are not connected with pathology of the peripheral analyzer concern to them.
Symptoms in the neighbourhood appear at a sdavleniye a tumor of nearby fabrics. The radicular syndrome arising at obolochechny or intramedullyarny tumors of a spinal cord can be an example.
The remote symptoms arise in connection with the shift of cerebral structures and a sdavleniye of the sites of a brain remote from the place of localization of a tumor.
More detailed information on symptoms of tumors of TsNS of various localization can be found in the articles "Intracerebral Tumours of Hemispheres of a Brain", "Cerebellum Tumours", "Tumour of an Epifiz", "Brain Trunk Tumours", "Tumours of a Spinal Cord".
Course of tumors of TsNS
The debut of clinical manifestations of new growths of TsNS and development of symptomatology can vary considerably eventually. Nevertheless, allocate several main types of their current. So, at the gradual beginning and development of focal symptomatology speak about a tumorozny current, at a tumor demonstration from an epipristup — about an epileptiformny current. The sharp beginning as a brain or spinal stroke, belongs to vascular type of a course of a tumor, meets at hemorrhage in new growth fabric. The inflammatory current is characterized by gradual deployment of symptoms as an inflammatory miyelopatiya or an encephalomeningitis. The isolated intra cranial hypertensia is in some cases observed.
During tumors of TsNS allocate several phases. The first — compensation phase — is followed only by an adynamy and emotional violations (irritability, lability). Focal and all-brain symptoms are practically not defined. In a phase of subcompensation all-brain manifestations, mainly in the form of moderate headaches, irritation symptoms — epileptic seizures, a giperpatiya, paresteziya, hallucinatory phenomena appear. Working capacity is broken partially. Neurologic deficiency is expressed in easy degree and often is defined how some asymmetry of muscular force, reflexes and sensitivity in comparison with the opposite side. At an oftalmoskopiya initial signs of stagnant disks of optic nerves can be revealed. Diagnosing of a tumor of TsNS in this phase is considered timely.
The phase of a moderate decompensation is characterized so-so by serious condition of the patient with the expressed violation of working capacity and decrease in household adaptation. Increase of symptoms, a prevalence of neurologic deficiency over irritation symptoms is noted. In a phase of a rough decompensation patients do not leave a bed. Deep neurologic deficiency, disorders of consciousness, warm and respiratory activity, the remote symptoms is observed. Diagnosis in this phase is overdue. The terminal phase represents irreversible violations of activity of the main systems of an organism. Disorders of consciousness up to a coma are observed. Brain hypostasis, a dislocation syndrome, hemorrhage in a tumor is possible. Death can come several hours later or days.
Diagnosis of a tumor of TsNS
Careful survey by the neurologist and collecting the anamnesis allows to assume existence of volume formation of TsNS. At suspicion of cerebral pathology the patient goes to the ophthalmologist where there takes place comprehensive examination of visual function: oftalmoskopiya, perimetry, visual acuity definition. All-clinical laboratory trials are conducted, at the assumption of adenoma of a hypophysis — determination of level of hypophysial hormones. Indirect data on existence of a tumor of a head or spinal cord can be received as a result of EEG, Ekho-EG and a X-ray analysis of a backbone respectively. The Lyumbalny puncture allows to judge a condition of a likvorodinamika. At a research of tserebrospinalny liquid in favor of a tumor testifies expressed , tumor cells are found not always.
Widespread introduction in practical neurology of methods of neurovisualization opened considerably great opportunities for diagnosis of a tumor of TsNS of any localization. It is necessary to consider that myagkotkanny structures of the vertebral channel are better visualized when carrying out MRT of a backbone, than at backbone KT. Carrying out MRT of a brain with contrasting is more preferable to diagnosis of tumors of TsNS of cerebral localization. To destination the neurosurgeon the spinal or cerebral angiography, the MR-angiography can be in addition carried out.
Diagnostic search at a tumor of TsNS includes also comprehensive inspection of the patient for identification of the remote metastasises or primary tumor. Carrying out MSKT of abdominal organs, KT of adrenal glands, ultrasonography of a thyroid gland, gynecologic ultrasonography, mammography, a X-ray analysis of lungs, skeleton stsintigrafiya, etc. is for this purpose possible.
The Stereotaksichesky biopsy of a cerebral tumor and punktsionny biopsy of a spinal tumor are carried out only in urgent cases at impossibility to precisely establish the diagnosis of a tumor according to the neurovisualizing researches. In most cases the biopsy of a tumor of TsNS and its histologic analysis are carried out intraoperatsionno.
Treatment of a tumor of TsNS
The main method of treatment of tumors of TsNS — surgical. Cerebral tumors operations can be performed by cranial trepanation or transnazalno. There is also a method of stereotaksichesky radio surgery of new growths of a brain. Spinal tumors operations include: removal of a meningioma, removal of a nevrinoma, removal ependimy. Removal of intramedullyarny tumors of a spinal cord and the cerebral tumors localized in the vital structures (for example, in a brain trunk) in most cases is not possible because of the brain substance damage interfaced to operation. According to indications it is carried out palliative interventions: partial resection of a tumor of TsNS, external ventrikulyarny drainage, decompression of the vertebral channel.
Radiative effects and chemotherapy can be used, both as palliative, and as preoperative and adjyuvantny treatment. Depending on a type of a new growth, its prevalence and an arrangement the combination, a dose, duration of a course and frequency of treatment is selected. Symptomatic therapy is in parallel performed.
Forecast of tumors of TsNS
The forecast of a new growth of TsNS in many respects depends on degree of its zlokachestvennost, the sizes, the nature of growth, prevalence, the location and a clinical phase in which the diagnosis was established. Owing to the features any tumors of TsNS lead to a serious and zhizneugrozhayushchy condition of the patient sooner or later. Benign tumors can slowly grow subklinichesk more than a decade. Malignant new growths often lead to a bystry decompensation and death of the patient within 1-2 years.