Neurosurgery: Brain Tumor

Risk Factors

• Most Primary Brain Tumors are Sporadic with No Identifiable Risk Factors
• Li-Fraumeni Syndrome
• Neurofibromatosis
• Ionizing Radiation

Most Common Location Mn

• Adults: Supratentorial (More Focal Sx)
• Peds: Infratentorial

Primary Tumor Types

• Most are Malignant
• Adults
  • *Metastases are the Most Common Brain Tumor in Adults Overall
  • Astrocytoma (Glioblastoma Multiform)
    • Most Common Primary Brain Tumor in Adults
  • Meningioma
  • Schwannoma
• Peds
  • Medulloblastoma
    • Most Common Brain Tumor in Peds
  • Pilocytic Astrocytoma
  • Ependymoma
  • Craniopharyngioma

Metastases

• Frequency:
  • In Adults, Metastases are More Common than Primary Brain Tumors
  • In Peds, Primary Brain Tumors are More Common than Metastases
• Types:
  • Lung Cancer – Most Common
  • Breast Cancer
  • Melanoma

Presentation

• Headache
• Seizures
• Focal Deficits – Weakness & Sensory Loss
• Memory Loss
• Personality/Mood Changes
• Increased Intracranial Pressure (ICP)

Diagnosis

• Initial Imaging: MRI with Contrast Preferred
• Primary Diagnosis: Pathology (Surgical or Stereotactic Biopsy)
  • Not Necessary for Multiple Metastases with a Known Primary Tumor

Treatment

• Definitive Management Depends on Pathology, Performance Status & Prognosis
• Options:
  • Surgical Resection
  • Stereotactic Radiosurgery (SRS)
  • Whole Brain Radiation Therapy (WBRT)
  • Chemotherapy
• Corticosteroids Can Reduce Peritumoral Edema – Helps with Some Symptomatic Relief
• May Require Antiepileptic Treatment