Jaroslav Jeřábek

Neuro-onkology

Incidence 4.5-13/100 000• 80% supratentorial (1/2 metastic)

• Frequency: metastases, glioblastoma

• Childhood: max.primary (70% infratentorial (3/4 cerebellum, ¼ brainstem)

Clasification

Acta Neuropathol. 2007 August; 114(2): 97–109.

Published online 2007 July 6. doi: 10.1007/s00401-007-0243-4

PMCID: PMC1929165

The 2007 WHO Classification of Tumours of the Central Nervous System

David N. Louis,1 Hiroko Ohgaki,2 Otmar D. Wiestler,3 Webster K. Cavenee,4 Peter C. Burger,5 Anne Jouvet,6 Bernd W. Scheithauer,7 and Paul Kleihues8

Metastic tumors• CNS parenchymal - mamma, lung,

melanoma

• hypofyseal- lung, melanoma

• meningeal- lung, prostat, mamma

• skull - mamma, prostat, osteosarcoma

• Spine- lung, mamma, prostat, colorect.

Meta lung ca

Symptoms• Localising: ep, fatic, hemiparesis, visual

field defects

• Nonlocalising: headache, unsciousness, changes of personality, attention, memmory, vertigo, papilary edema

Be aware of tumor

• Headache- 60%

• Epilepsy- 30%

• Progression of focal signs- 20%

Progression of focal signs

Chiasma

Bitemporal hemianopsy

Hormonal changes

• Prolaktinom

• HGH – akromegaly

• ACTH – Cushing

• hypopituitarismus

Haemorhage in tumor = acute signs

CT

fMRI

MRI spectroscopy

Headache

• night, in the morning, worsened by Valsalva maneuver

• Change of type of chronic headache

• Persisting “aura”

psychologicalchanges

• personality

• memory

• organic psychsyndom

• pseudoneurasthenia

• behaviour - agressivity, passivity

Epileptic paroxysm

• CAUTION: secondarity

• MRI

• CAUTION: non-contrast CT

Neurologic signs

• Neurostatus can be normal

• Hydrocefalus- infratentorial tu

• Brainstem symptoms

• Foster-Kennedy: visual loss+ contralat. papiledema (meningeoma os.sphenoidale)

• Hemichorea: BG (astrocytoma, lymfoma)

• Everything

Spinal tumors

• Intramedular (ependymoma, asrocytoma): pain +, sensitivity-, sphincters, spasticity, pyramidal signs

• Intradural, extramedulary(meningeoma): pain + - +++(meta), radicular signs - paresis, pyramidalsigns

• Epidural (meta): pain +++, radikular sy

Vertebromedulartopography

Neurosurgery

• Biopsy

• Localisation malignanacy

• Internal tumor decompression

• fMRI

Radiotherapy• Radiation

• Radiosurgery- gamma knife, X knife, Novalis robotic 6D system

• Postiaradiation necrosis

• antiedematous treatmen (steroids)

• myelopathy (radiation)

Radioth planning

Chemoterapie

• Součást kombinované léčby

• Tumory NS většinou nepříliš sensitivní

• definovaná schémata

Conservative treatmentICH• Dexamethazon inj. a tabl.

• Mannitol

• Glycerin

• Arteficial hyperventilation

Antiepileptics

Psychotherapy, rehabilitation, etc

Outcome

• Type, lokalisation

• Glioblastoma - 12-15 m.

• Meningeoma - rarely reocurring

• Watch and wait (schwannomas)

Don´t forget !

• Headache- 60%

• Epileptic paroxysm- 30%

• Progression of focal signs - 20%

• Neuroradiology