Intracerebral tumors of hemispheres of a brain
Intracerebral tumors of hemispheres of a brain — the benign and malignant tumors which are settling down directly in brain tissues. Tumors of hemispheres of a brain are shown all-brain (a headache, stagnation of disks of optic nerves, dizziness, vomiting, mental violations) and focal (motive violations, sensitivity losses, visual frustration, violations of the speech, a neuro and endocrine syndrome and so forth) by symptoms. Diagnosis of a tumor of hemispheres of a brain includes an oftalmoskopiya, EEG, Ekho-EG, brain KT and MPT, a stereotaksichesky biopsy. Treatment of a tumor of hemispheres of a brain can include radical or its partial removal, a surgical decompression of a brain, chemotherapy, radiation therapy and symptomatic treatment.
Intracerebral tumors of hemispheres of a brain
Intracerebral tumors of hemispheres of a brain occupy about 1,4% of all malignant tumors. 2,4% of all lethal outcomes connected with a disease of cancer both in the adult, and at children's age fall to their share. Incidence of tumors of hemispheres of a brain makes 3,7 on 100 thousand people. Now the tendency to growth of this indicator is noted. Tumors of hemispheres of a brain in pediatric practice meet considerably less than at adult patients. Aged people from 20 to 50 years are subject to the greatest incidence. Intracerebral tumors of hemispheres of a brain are a subject of joint studying of neurology, oncology and neurosurgery.
Causes of a tumor of hemispheres of a brain
Radiation is the indisputable reason of development of a tumor of hemispheres of a brain. It is confirmed by developing of intracerebral tumors at the patients undergoing radiation therapy in connection with various diseases. It is supposed that the risk of developing of a tumor of hemispheres of a brain increases at the aspartame sugar substitute use, vinyl chloride influence, adverse influence of electromagnetic fields when using the mobile phone.
Some authors connect tumors of hemispheres of a brain with violations in immune system which can have congenital character, are observed at sick HIV or are a consequence of immunosupressorny therapy. It is also noticed that a number of tumors of hemispheres of a brain is associated with such diseases as a tuberozny sclerosis, Gippelya-Lindau's disease, a neurofibromatosis of Recklinghausen.
Classification of tumors of hemispheres of a brain
Division of tumors of hemispheres of a brain on primary and secondary is basic (metastatic). Primary tumors of hemispheres of a brain in the majority develop from glial elements, for as glial tumors received the name. From them the astrotsitoma most often meets. A passion primary tumors of hemispheres of a brain originating in soyedinitelnotkanny structures (for example, in a cover of vessels of a brain) and ferruterous fabric meet. Sarcomas and angioretikulema, adenomas concern to them.
Metastatic tumors of a brain represent metastasises of malignant tumors of extra brain localization. More often others in a brain are spread by lung cancer, the second place on the frequency of intracerebral metastasises is taken by a breast cancer. Less often secondary tumors of hemispheres of a brain arise at metastasises of a melanoma, a gipernefroma, a retinoblastoma, tumors of adrenal glands, etc.
Symptoms of a tumor of hemispheres of a brain
All-brain symptoms of an intracerebral tumor of hemispheres of a brain are connected with increase in intra cranial pressure (hydrocephaly). And degree of hypertensia does not depend directly on the tumor sizes. So, small tumors of hemispheres of a brain can lead to violation of a likvorodinamika and essential increase in intra cranial pressure, and tumors of the big sizes sometimes are followed by ill-defined all-brain symptomatology. Treat all-brain symptoms: headache, dizziness, vomiting, defeat of disks of optic nerves, mental disorders, epileptic attacks.
At an intracerebral tumor of hemispheres of a brain the headache has the stupid holding apart diffusion character. In an initial stage it usually arises periodically, and then becomes a constant. Often patients note reduction of intensity of a headache at a certain position of the head (as a rule, in a prone position on the struck side of the head).
Characteristic clinical symptom of a tumor of hemispheres of a brain is dizziness. It has pristupoobrazny system character in the form of feeling of own rotation or rotation of surrounding objects. Dizziness can be followed by other symptoms of a vestibular ataxy, nausea, vegetative violations, noise in ears. Usually at a tumor of hemispheres of a brain, unlike a cerebellum tumor, dizziness develops at later stages of a disease at considerable likvorny hypertensia.
Distinctive feature of vomiting at a tumor of hemispheres of a brain is its emergence out of communication with meal; most often in the morning on an empty stomach. Also vomiting is often observed at peak of a headache. As vomiting leads to reduction of a headache, some patients for this purpose specially cause an emetic reflex. At tumors of the IV ventricle and a cerebellum vomiting can arise without headache and be provoked by change of position of a body.
Defeat of disks of optic nerves in most cases is bilateral and is caused by development of developments of stagnation in them under the influence of constantly increased intra cranial pressure. Stagnant disks of optic nerves are an early symptom of a tumor of hemispheres of a brain and can come to light at an oftalmoskopiya when subjective feelings of patients are still poorly expressed. Damage of optic nerves is clinically shown by flashing of "front sights" before eyes, periodically arising "fog" in eyes. At the same time, unlike neuritis of an optic nerve, it is long visual acuity remains. About a current of time stagnant changes can lead to an atrophy of an optic nerve.
Often at a tumor of hemispheres of a brain mental disorders are observed. They can have the most various character from violations of the mnestichesky sphere (memory, attention, thinking) and psycho-emotional reorganization of the personality (the increased irritability, aggression or opposite apathy, excessive complacency) to heavy mental disorders (hallucinations, nonsense, twilight conditions of consciousness). Gradual progressing of mental deviations is characteristic though at the malignant nature of a tumor of hemispheres of a brain this process proceeds quickly enough.
Quite often tumors of hemispheres of a brain are followed by an epileptic syndrome. Most often it is observed at a process arrangement in a temporal share (temporal epilepsy). Various types of Epi attacks from small to primary and generalized are possible. The nature of the aura preceding an attack often allows to assume approximate location of a tumor.
Distinguish primary focal symptomatology of a tumor of hemispheres of a brain, the arising direct impact of a tumor on the fabrics surrounding it, and secondary — caused by the shift and infringement of structures of a brain, remote from a tumor, ishemizatsiy the brain fabrics located far from a tumor, but the vessels squeezed by it.
At the tumor of hemispheres of a brain which is localized in a frontal lobe to the forefront there is a frontal syndrome: psychomotor frustration, change of behavior, emotional and strong-willed sphere. Delay of the speech and thinking, paresis of a facial nerve of the central type, emergence of a hvatatelny reflex, generalized Epi attacks with the previous tonic spasms and violent turn of eyes and the heads is characteristic.
The tumors of hemispheres of a brain located in a parietal share are followed by violations of sensitivity and musculoarticulate feeling, disorders of perception of own body. Tumoral defeat in a prepotent hemisphere is led to violation of the account, letter (dysgraphia) and readings (dyslexia).
Tumors of hemispheres of a brain in a temporal share differ in early emergence of Epi attacks. Difficult acoustical and visual hallucinations, unpleasant visceral feelings are possible. Tumors of the left temporal share lead to emergence of touch aphasia. Defeat of zadnevisochny departments proceeds with development of a gomonimny gemianopsiya (loss of the half of the same name of fields of vision).
The tumors of hemispheres of a brain located in an occipital share are shown by various disorders of visual function: partial or full gemianopsiya, visual hallucinations, fotopsiya and metamorfopsiya, optical agnosia.
Tumors of hemispheres of a brain in the field of the Turkish saddle (for example, hypophysis adenomas) are followed by a neuro and endocrine syndrome. Depending on age of the patient, character and localization of a tumor the akromegaliya, giantism, a hypophysial nanizm, Itsenko-Cushing's disease can be observed, women have a violation of a menstrual cycle, . Tumors of a shishkovidny body at children's age lead to early puberty.
Tumors of a calloused body bring to pronounced mental frustration and to violations of orientation in space. Tumors of hemispheres of a brain in the field of subcrustal structures demonstrate increase in intra cranial pressure and early stagnant changes of visual disks. Then sensitivity violations, vegetative symptoms (, lability of pulse and arterialno pressure, a difference of temperatures of skin of various parts of the body), violent laughter and crying, a maskoobraznost of the person join.
Diagnosis of a tumor of hemispheres of a brain
The neurologist can suspect an intracerebral tumor according to complaints of the patient and the revealed violations of the neurologic status. The exception of a tumor of hemispheres of a brain is necessary at all patients with for the first time arisen Epi attacks. Inspection at the ophthalmologist with visual acuity definition, carrying out perimetry and an oftalmoskopiya is obligatory. At a hearing disorder consultation of the otolaryngologist is appointed, at existence of a neuro and endocrine syndrome — the endocrinologist, and for women in addition of the gynecologist-endocrinologist.
Tumors of hemispheres of a brain in most cases are followed by the considerable hydrocephaly revealed during Ekho-EG. If the tumor causes the shift of structures of a brain, then the shift of echo signals from the average line is found. By means of EEG define existence of epileptic activity. REG at a tumor of hemispheres of a brain often gives data on these or those violations of intracerebral blood circulation which can be connected with a reflex vascular spasm or a sdavleniye of vessels the growing tumor.
Neurovisualization methods are recognized as the best ways of objective detection of a tumor of hemispheres of a brain: KT and MRT of a brain. They allow to define exact localization of a tumor of hemispheres of a brain and to differentiate it from an intracerebral hematoma, a cyst at a siringomiyeliya, abscess of a brain, multiple sclerosis, epilepsy. However allows to make the authentic diagnosis and to verify tumors of hemispheres of a brain only a histologic research. It can is carried out with the samples of brain fabric received during a stereotaksichesky biopsy or intraoperatsionno.
Treatment of a tumor of hemispheres of a brain
Its surgical removal remains by the main method in treatment of a tumor of hemispheres of a brain. Benign intracerebral tumors of hemispheres of a brain reaching the size no more than 3,5 cm can be removed with application of stereotaksichesky radio surgery. Unfortunately, removal of glial tumors often is impossible because of their considerable germination in surrounding brain fabric. Full removal of not glial tumors is possible only at their good-quality character. Removal of ventrikulyarny tumors presents considerable difficulties for neurosurgeons. In cases when it cannot be executed in full in addition perform the shunting operation. Removal of metastatic tumors is possible if they have single character or are localized in one zone.
At an inoperable tumor of hemispheres of a brain carrying out the palliative interventions directed to decrease in degree of hydrocephaly and the prevention of dislocation of brain structures is possible. Decompressive cranial trepanation, external ventrikulyarny drainage, ventrikuloperitonealny shunting concern to them.
Surgical treatment of a tumor of hemispheres of a brain is often combined with beam and chemotherapy. Radiation is carried out usually in the mode of remote gamma therapy in 1-2 weeks after the performed operation. Conditions of carrying out effective chemotherapy is exact verification of a tumor and definition of sensitivity of the patient to a himiopreparat. The chemotherapy is carried out by courses with obligatory control of indicators of blood and the accompanying antiemetic therapy. It can be carried out by local introduction of medicines to likvorny system or directly in a tumor bed.
Forecast of a tumor of hemispheres of a brain
The favorable forecast is observed in case of an angioretikulema or adenoma on condition of its radical surgical removal. Glial tumors of hemispheres of a brain differ in a frequent retsidivirovaniye, duration of postoperative survival of patients at them depends on tumor zlokachestvennost degree.