Kraniospinalny tumors — the new growths sprouting through a big occipital opening and located at the same time in kaudalny departments of a brain and the top spinal segments. Are clinically shown by frustration of a likvorotsirkulyation, focal symptoms of defeat of structures of a back cranial pole and spinal symptomatology. Kraniospinalny tumors on a clinical picture and its development, this MPT or KT of kraniospinalny area, results of an intraoperative biopsy are diagnosed. The most radical method of treatment — neurosurgical removal of a new growth. In case of inoperabelny and partially rezetsirovanny tumors kraniospinalny radiation is applied.
Kraniospinalny tumors represent a neoplasia, passing through a big occipital opening. Meet at persons more often is more senior than 30-year age. Are described in the middle of the 19th century, are most in detail stated in D. K. Bogorodinsky's monograph published in 1936. Growth of a new growth can come from structures of a back cranial pole with distribution in the descending direction on substance and covers of the top departments of a spinal cord. In other cases the neoplasia originates in cervical spinal segments, grows in the ascending direction and sprouts in a back cranial pole. In spinal area the new growth can have ekstramedullyarny or intramedullyarny character. In the first case it sprouts the fabrics surrounding a spinal cord, without getting into brain substance, in the second — extends in the most spinal substance. The tumors which are also mixed extra- meet.
Classification of kraniospinalny tumors
On the genesis kraniospinalny tumors happen primary and secondary — metastatic. The last are observed at oncological damage of internals, for example, at a granular and cellular carcinoma of a kidney, cancer of a thyroid gland, stomach cancer, gullet cancer, a breast cancer, etc. Kraniospinalny tumors are presented in the morphological plan by gliomas (medulloblastoma, ependimoma, nevrinoma, astrotsitoma), fibrosarkoma and obolochechno-vascular new growths (angioretikuloma, gemangioblastoma, meningioma). Extremely seldom in a kraniospinalny zone teratoma, holesteatoma, lipomas meet.
In practical neurology classification of kraniospinalny neoplaziya on intra stem (intrabulbarny), extra stem and metastatic is applied. Intrabulbarny new growths start in a trunk and sprout in a spinal cord or have initially spinal localization and grow in a trunk. In the latter case the term "intramedullyarno-bulbarny educations" is applied to them. Extra stem kraniospinalny tumors include spinalno the sprouting new growths of the IV ventricle, a cerebellum, a duralny cover of a back cranial pole, a nevrinoma of the IX-XII craniocereberal nerves and new growths of spinal backs growing in a back cranial pole. Extra stem tumors cause a compression of a trunk and thereof can be followed by stem symptomatology.
Symptoms of kraniospinalny tumors
Clinical manifestations of neoplaziya of kraniospinalny area vary according to an arrangement and the nature of growth of a tumor. In general they can be divided into 3 syndromes.
Syndrome of frustration of a likvorotsirkulyation. It is connected with a compression of likvorny ways, violation of the message between a cavity of a cranium and the spinal channel, difficulty of a likvoroottok with development of okklyuzionny hydrocephaly and intra cranial hypertensia. Tsefalgiya (headaches) often having a pristupoobrazny current are characteristic. Nausea, feeling pressure upon eyeballs from within, vomiting at peak of a tsefalgiya is noted. Over time there are okklyuzionny paroxysms with disorder of breath and heavy vegetative manifestations. Oftalmoskopiya gives a picture of stagnant disks of optic nerves.
Syndrome of focal damage of a brain. It is caused by germination of a new growth in cerebral structures of a back cranial pole and their compression as a tumor, and owing to hydrocephaly. Dizzinesses, vomitings without the expressed tsefalgiya, a cerebellar ataxy, are observed. Due to the defeat IX, X, XI and XII cranial nerves arise bulbarny violations — a poperkhivaniye during food, swallowing difficulty, throwing of liquid food in a nose, a nasal shade of a voice, the muffled speech. Cardiovascular and respiratory frustration are possible.
Syndrome of spinal defeat. It is caused by germination of a tumor in spinal structures (substance, backs) or their sdavleniye with an ekstramedullyarny growth of a new growth. At 85% of patients begins with neuralgic symptoms — pains and paresteziya in a neck, a nape, a humeral belt and hands; rigidnost of zadnesheyny muscles. Then there comes the stage of sensomotorny frustration. Usually at first there is paresis, and then loss of sensitivity and dysfunction of pelvic bodies is observed. Violations can has gemiplegichesky or paraplegichesky character. In the first option the hemiparesis is gradually transformed to tetraparesis, in the second — lower joins the top paraparesis. The distinctive feature characterizing kraniospinalny tumors is existence against the background of the spastic nature of paresis of segmentary atrophies of muscles of hands and a humeral belt. In some cases signs of a syndrome of Broun-Sekar come to light.
Course of kraniospinalny tumors
The debut and dynamics of development of a clinical picture depend on localization of initial growth of a new growth, the direction of its distribution and volume of tumoral fabrics. Primary neoplasia in a back cranial pole, as a rule, demonstrates symptoms of intra cranial hypertensia, syndromes of focal damage of a cerebellum and a trunk of a brain, and the spinal simptomokompleks appears much later. The new growth originating at the level of spinal segments, on the contrary, debuts from a syndrome of spinal defeat, and signs of frustration of a likvorotsirkulyation and postcranial symptoms arise then.
The sequence of emergence of symptomatology allows the neurologist to differentiate initially postcranial and initially spinal new growths, and also to assume the extra-or intramedullyarny nature of a tumor at the spinal level. Such differentiation of kraniospinalny tumors confirmed with data of a magnetic and resonant tomography has crucial importance in treatment planning.
Diagnosis of kraniospinalny tumors
During diagnostics not only the careful research of the neurologic status of the patient, but also detailed collecting the anamnesis with specification of dynamics of emergence and development of symptomatology is necessary. Consultation of the ophthalmologist can reveal edematous disks of optic nerves that confirms existence of intra cranial hypertensia. X-ray analysis of cervical department of a backbone of a maloinformativn. The research of tserebrospinalny liquid reveals proteinaceous and cellular dissociation, in some cases it is combined with yellowish coloring of a likvor (ksantokhromiya).
Application of a contrast miyelografiya is possible. But more modern and exact way of diagnosis of kraniospinalny tumors is MRT. MRT of a brain and MRT of a backbone in cervical department, aim MRT of a kraniovertebralny zone is carried out. Additional contrasting is as necessary applied. In the absence of a possibility of MRT-diagnostics, resort to a computer tomography and vascular inspections (KT of vessels). It is necessary to differentiate kraniospinalny tumors from a hernia nuclei pulposi and the caused osteochondrosis radicular syndrome in verkhnesheyny department of a backbone, kraniovertebralny anomalies, bulbarny option the BASS, siringomiyeliya, multiple sclerosis. Exact verification like a neoplasia is carried out mainly by an intraoperative biopsy.
Treatment and forecast of kraniospinalny tumors
The only effective way of treatment of new growths of kraniospinalny localization is their radical removal. The possibility of the last is big at extra stem and ekstramedullyarny tumors, especially with their focal growth. The Intrabulbarny, intramedullyarny, and also infiltrative growing kraniospinalny tumors delete, avoiding an excessive travmatization of brain fabrics. Despite use of the microsurgical equipment, in similar cases it is possible only a partial resection of a tumor. Neurosurgical operation is carried out in 2 steps with use of 2 accesses. As access to a back cranial pole serves its trepanation, access to spinal structures — a laminektomiya of the first and, if necessary, the second cervical vertebras. Sequence of removal of parts of a tumor is dictated by their size and a prevalence of cerebral or spinal symptoms. For the prevention of the subsequent hydrocephaly operation can come to an end with ventrikuloperitonealny shunting.
In treatment application of kraniospinalny radiation is possible. It is used in inoperabelny cases, as preoperative treatment at bystry progressing of neurologic symptomatology, after the carried-out removal of a new growth at its proved rentgenchuvstvitelnost. At children according to indications the adjyuvantny polychemotherapy is appointed (platinum medicines, vinkristiny, lomustiny).
The forecast depends on a type of a new growth, its arrangement and prevalence. Focal extra stem ekstramedullyarny tumors can have rather favorable outcome. For timely identification of a recurrence after surgical treatment patients are subject to regular observation at the neurosurgeon with MRT-control performance. Necessary frequency of surveys varies depending on type of tumoral process.