Signs of a brain tumor. Intracranial tumor Tumor of the deep parts of the brain

Relevance. As is known, the base of the skull performs a very specific physiological function as a link between the brain skeleton and the facial structure and the skull as a whole with the spinal column. In addition, the base of the skull consists of many dissimilar organs and tissues, as a result of which tumors of this localization usually cause combined damage to several anatomical zones and lead to the development of pronounced clinical symptoms. Despite the successes of modern chemoradiotherapy, when some types of tumors, for example, nasopharyngeal cancer, are successfully treated conservatively, the main method of treating tumors of the skull base is surgical. When determining the scope of surgical intervention, it is necessary to take into account the fact that during interventions on the base of the skull for oncological diseases, too extensive combined defects arise, which themselves can lead to the development of complications incompatible with life, among which the most dangerous are meningoencephalitis, stroke, thrombosis cerebral sinuses, air embolism, traumatic spinal cord injury.

Definition. The term “tumors of the skull base,” being a collective term, unites a variety of tumor processes characterized by damage to a very specific anatomical formation.

The anatomical boundaries of the base of the skull are considered to be a complex of bone structures located below the line connecting the intersection of the frontonasal suture and the midline (nasion) with the external occipital protrusion (inion). It should be noted that there is an external and internal base of the skull. Considering this circumstance, we classify as tumors of the skull base not only those that manifest themselves as lesions of the internal base, but also tumors localized in the structures that make up the external base, such as cells of the ethmoidal labyrinth, orbit, infratemporal and pterygopalatine fossa, cervico-occipital joint.

Anatomically, the “base of the skull” (BS) is a complex of bone structures located below the line connecting the intersection of the frontonasal suture and the midline of the skull (nasion) with the external occipital protrusion (inion). Radiologically, the OB looks like a thin bone plate, as a result of which some authors classify as OB tumors only those clinical variants that are accompanied by radiological signs of destruction of this plate. In fact, the nosological range is represented by a wide range of neoplasms localized within the true anatomical boundaries of the OB, in which the external (NOC) and internal (IOC) bases are distinguished (Vinokurov A. G., 2004).

In this case, the structures that make up the night include: cells of the ethmoidal labyrinth (labyrinthus ethmoidalis), orbit (orbita), main sinus (sinus sphenoidalis), superior nasal passage (meatus nasi superior) and cribriform plate (lamia cribrosa), nasopharynx (nasopharynx) , infratemporal (fossa infratemporalis) and temporal fossa (fossa temporalis), foramen magnum (forame occipitale magum), condyles of the occipital bone (codylus occipitalis). The VOC is divided into three anatomical regions: the anterior (fossa cranii anterior), middle (fossa cranii media) and posterior cranial fossa (fossa cranii posterior). Considering the above, tumors of the OB include not only those that manifest themselves as lesions of the OM, but also tumors localized in the structures that make up the OM, such as the cells of the ethmoidal labyrinth, the orbit, the infratemporal and pterygopalatine fossa, the cervico-occipital joint, etc.

Please note! Thus, the tumor is an anatomical and topographical complex consisting of many dissimilar organs and tissues, as a result of which tumors of this localization usually cause combined damage to several anatomical zones and lead to the development of severe clinical symptoms. According to the literature, the prevalence of tumors affecting the OB, orbital region, paranasal sinuses and facial region does not exceed 2 - 3% among brain tumors.

More often, damage to the OB occurs secondary to local spread of the tumor process in neighboring locations (nasal cavity, infratemporal fossa, cranial cavity, etc.) and with [secondary] metastatic damage; less often - primarily when a tumor develops directly from the bone structures that make up the base of the skull. Among the tumors affecting this area, there are malignant (squamous cell carcinoma, esthesioneuroblastoma, osteosarcoma, etc.) and benign neoplasms (angiofibroma, fibrous dysplasia, meningioma, etc.). It is also optimal to conditionally divide tumors affecting the base of the skull according to the projection of the three cranial fossae, since it is very convenient in planning the scope of surgical intervention, which plays a major role in the treatment of this pathology. For example, in the projection of the anterior cranial fossa there are tumors emanating from the maxillary and frontal sinuses, cells of the ethmoidal labyrinth, and orbits; middle - tumors of the main sinus, nasopharynx, infratemporal and pterygopalatine fossae, middle ear; posterior - tissues that make up the cervical-occipital joint.

Please note! OC metastases are a manifestation of a late stage of cancer, are associated with a poor prognosis, and in 44 - 100% of cases, at the time of diagnosis of “cranial metastasis,” there is a disseminated oncological process. However, in some cases, metastases in the OB are the first manifestation of a malignant tumor, reaching 28% in some studies. The most common sources of metastasis in the OB are the mammary gland, lungs, and prostate.

Clinical manifestations Tumors affecting the OB are diverse and nonspecific and mainly depend on the primary localization of the tumor and the involvement of neighboring structures in the process: cranial nerves (most often I - VI cranial nerves), great vessels, tissues of the brain and spinal cord.

The first place in the frequency of lesions in the cerebral cortex is occupied by tumors of the paranasal sinuses, which in approximately 15% of cases spread to the area of ​​the anterior cranial fossa. Most often these are epithelial tumors, among which squamous cell carcinoma occurs in most cases (50 - 80%). When a tumor grows into the orbit, diplopia, ptosis, exophthalmos, and oculomotor disturbances may appear. When the lacrimal apparatus is damaged, dry sclera and trophic disorders of the eye occur. When the optic nerve is compressed in its canal, a decrease in visual acuity and loss of visual fields occurs. When the tumor spreads to the area of ​​the superior orbital fissure and the anterior parts of the cavernous sinus, facial hypoesthesia and oculomotor disturbances occur.

Tumors affecting the maxillary sinus may present with tooth loss and trismus. Often, tumors of the paranasal sinuses are mistaken for various inflammatory processes (sinusitis, sinusitis, etc.), which is why most patients (70 - 90%) enter the clinic with an already widespread tumor process. Among the main symptoms are congestion, dysphonia and periodic bloody discharge from the nose, hypo- or anosmia (due to impaired function of the primary olfactory structures), decreased hearing on the affected side, often with infiltrative tumors of the nasopharynx - a combined lesion of n. abducens (VI) and n. facialis (VII), manifested by adductor strabismus and paresis of facial muscles, decreased sensitivity of the facial skin, neuralgia, exophthalmos.

Chronic unilateral serous otitis media may be due to a malignant tumor of the nasopharynx that blocks the Eustachian tube. Tumors of the infratemporal fossa clinically occur as parapharyngeal and most often manifest as displacement of the lateral wall of the pharynx to the midline, dysphagia, and difficulty breathing; in case of malignant tumors with infiltrative growth, progressive headaches associated with involvement of the internal carotid artery, laryngeal paresis due to damage to the vagus nerve, Horner's syndrome due to damage to the sympathetic trunk may occur.

In cases where the tumors are located in the projection of the posterior cranial fossa, the clinical picture resembles cervical osteochondrosis - pain in the cervical spine, periodic headaches, dizziness, vestibular disorders. When the tumor spreads into the cranial cavity, manifestations of focal neurological symptoms, which depend on the location of the lesion, come to the fore. When the base of the anterior cranial fossa is destroyed and the base of the frontal lobes is invaded, cognitive-mnestic disorders, personality disorders, and signs of intracranial hypertension occur.

H. Greenberg et al. (1981) identified several syndromes in accordance with clinical and neurological symptoms. Thus, tumor growth into the orbit is clinically manifested by orbital syndrome, when the tumor is located in the middle cranial fossa - sellar, parasellar syndromes, syndromes of damage to the temporal bone pyramid and Gasserian ganglion; damage to the occipital region of the skull may cause occipital condyle syndrome, etc.

Orbital syndrome is characterized by dull pain in the supraorbital area above the affected eye, associated with diplopia and other disturbances of binocular vision. In some cases, exophthalmos and oculomotor disturbances are observed with changes in sensitivity in the area of ​​innervation of the first branch of the trigeminal nerve. The tumor may be palpable in the orbit. Some authors describe periorbital edema and decreased vision due to damage to the optic nerve.

Sellar syndrome can manifest itself as a clinical picture of hypopituitarism (but this requires almost complete destruction of the adenohypophysis); damage to the neurohypophysis or pituitary infundibulum often provokes diabetes insipidus; lateral spread of the tumor causes nerve damage in the cavernous sinus, which is why some authors combine sellar and parasellar syndromes.

Parasellar syndrome (cavernous sinus syndrome) is manifested by oculomotor disorders and damage to one or more branches of the trigeminal nerve. The syndrome is characterized by unilateral supraorbital frontal pain or oculomotor nerve palsy without proptosis. Visual disturbances are rare and occur in late stages of the disease. The combination of cavernous sinus syndrome with early vision loss is a common manifestation of systemic lymphoma, characterized by a high affinity for the cavernous sinus. Sometimes there are complaints of paresthesia and facial pain in the area of ​​innervation of the affected branch of the trigeminal nerve. A neurological examination reveals ophthalmoplegia, numbness in the face, and, rarely, periorbital edema. Rare cases of bilateral ophthalmoplegia have been described.

Middle cranial fossa syndrome (Gasserian ganglion syndrome) is characterized by paresthesia, numbness and pain in the face, which has a shooting character, reminiscent of trigeminal neuralgia. Headache, unlike parasellar syndrome, is rare. Sensitivity disturbances are detected in the area of ​​innervation of the 2nd and 3rd branches of the trigeminal nerve, less often in the area of ​​innervation of the first branch. Involvement of the motor branch of the V nerve in the process is manifested by homolateral weakness of the masticatory muscles. Some patients experience combined abducens nerve palsy.

Occipital condyle syndrome is characterized by persistent acute pain in the unilateral occipital region of the skull and palsy of the XII (hypoglossal) nerve. The pain is acute, constant, one-sided, intensifies and radiates to the frontal region when bending the neck or turning the head in the opposite direction. There is stiffness in the neck. Almost all patients experience dysarthria and dysphagia due to difficulty moving the tongue. Paralysis of the hypoglossal nerve can be isolated; on the side of the pathological formation, the tongue is weak and atrophic. Bilateral hypoglossal nerve involvement is rarely described.

Diagnostics. If the presence of a tumor is suspected, after a physical examination, patients are referred to MRI and CT scan of the brain with contrast enhancement. These types of neuroimaging make it possible to determine the presence and extent of a tumor lesion, identify signs of intracranial hypertension and tumor invasion of the dura mater and brain tissue, suggest a histological diagnosis and the possibility of endoscopic biopsy. The next step is histological verification of the process. The presence of an accessible part of the tumor in the area of ​​the lower and middle nasal passages allows a biopsy to be performed under local anesthesia. When the tumor is located in the paranasal sinuses, the area of ​​the upper nasal passage, or the structures of the ethmoid bone, it becomes necessary to perform a biopsy under anesthesia. Histological diagnosis in some situations immediately indicates the primary or metastatic nature of the tumor. Thus, esthesioneuroblastoma is a primary malignant tumor of the olfactory epithelium, and the presence of kidney cancer cells in samples indicates the metastatic nature of the lesion. In other cases, for example, with squamous cell carcinoma, the primary lesion may be located either at the site of the biopsy or have a different localization, located in other organs. Recently, immunohistochemical examination has helped to determine the primary lesion.

Please note! When a primary malignant tumor affecting the OB is detected, the examination should include at least the following studies: [ 1 ] taking anamnesis; [ 2 ] physical examination; [ 3 ] endoscopic ENT examination (if necessary); [ 4 ] MRI and CT scan of the head with contrast; [ 5 ] dental examination; [ 6 ] Ultrasound of the lymph nodes of the neck and supraclavicular space; [ 7 ] biopsy of the lymph node if it is more than 3 cm in diameter; [ 8 ] MRI of the neck if metastasis is detected in the lymph node of the neck; [ 9 ] CT scan of the chest; [ 10 ] PET-CT with glucose (PET - positron emission tomography, - whole body with glucose is a highly sensitive and specific - up to 90% method for identifying possible metastases in the lymph nodes, skeletal bones and internal organs and determining the stage of the lesion).

Treatment patients with OC tumors require an interdisciplinary approach to treatment with the participation of oncologists-surgeons (who deal with tumors of the head and neck), ENT surgeons, neurosurgeons, in some cases, maxillofacial and plastic surgeons, as well as radiologists, radiologists, and chemotherapists. Currently, a complex method that combines chemoradiotherapy with surgery is considered to be the most appropriate in the treatment of patients with OC lesions. Combined damage to both orbits, optic chiasm, damage to the brain stem, transverse and sigmoid sinuses, extended damage to the internal carotid artery are factors that greatly limit the radicalism of the intervention performed. Most authors in such cases are inclined to the need for preoperative chemoradiation therapy in order to reduce the size of the tumor focus to the point where it is possible to perform a functionally preserved surgical intervention without compromising radicalism. Perhaps the only limitation in carrying out such a treatment technique is the resistance of the tumor to chemoradiotherapy (osteogenic sarcomas, chondrosarcomas, meningiomas, etc.). In such cases, as well as when after the chemoradiotherapy stage it is not possible to achieve pronounced tumor regression, it is advisable to conduct a course of postoperative radiation therapy in order to devitalize microscopic residual foci - areas of development of potential relapses. The main criterion in this case is the morphologically confirmed presence of tumor cells in the resection margin.

Read more about OC tumors in the following sources:

dissertation abstract for the academic degree of Doctor of Medical Sciences “Tumors of the base of the skull. Clinic, diagnosis, treatment” Mudunov Ali Muradovich; The work was carried out at the institution of the Russian Academy of Medical Sciences, Russian Oncology Research Center named after N.N. Blokhin RAMS; Moscow, 2010 [read];

dissertation for the degree of Doctor of Medical Sciences “Tactics of treatment of benign tumors of the anterior and middle sections of the skull base based on assessment of the dynamics of neurological symptoms and disease outcomes” Anna Borisovna Kadasheva, Federal State Institution “Research Institute of Neurosurgery named after. acad. N.N. Burdenko" Ministry of Health of the Russian Federation, Moscow, 2016 [read];

article (review) “Epidemiology, diagnosis, clinical symptoms and classification of primary malignant tumors affecting the base of the skull” by D.S. Spirin, G.L. Kobyakov, V.A. Cherekaev, V.V. Nazarov, A.B. Kadasheva, E.R. Vetlova, K.V. Gordon; FGAU "Research Institute of Neurosurgery named after. acad. N.N. Burdenko" of the Ministry of Health of Russia, Moscow; MRNC named after. A.F. Tsyba - branch of the Federal State Budgetary Institution "NMRRC" of the Ministry of Health of Russia, Moscow (magazine "Questions of Neurosurgery" No. 3, 2016) [read];

article “Tumors of the skull base of the chondroid series (literature review)” by T.G. Gasparyan, V.A. Cherekaev, A.Kh. Bekyashev; FSBI "RONC named after. N.N. Blokhin" RAMS, Moscow; FSBI "Research Institute of Neurosurgery named after. acad. N.N.Burdenko" RAMS, Moscow; Department of Neurosurgery, State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Postgraduate Education" of the Ministry of Health of Russia, Moscow (magazine "Tumors of the Head and Neck" No. 3, 2012) [read];

article “Current issues of pathogenesis and diagnosis of secondary (metastatic) neoplasms of the skull base. Literature review” M.A. Stepanyan, V.A. Cherekaev, D.L. Rotin Research Institute of Neurosurgery named after. acad. N.N. Burdenko RAMS, Moscow (journal “Head and Neck Tumors” No. 2, 2011) [read];

article “Problems of diagnosis and treatment of tumors of the skull base and infratemporal fossa” by A.M. Mudunov, Research Institute of Clinical Oncology, State University Russian Cancer Research Center named after. N.N. Blokhin RAMS, Moscow (magazine “Bulletin of the Russian Scientific Research Center named after N.N. Blokhin RAMS” No. 1, 2006) [read];

article “Occipital condyle syndrome as a clinical manifestation of metastases to the base of the skull” Cherekaev V.A., Stepanyan M.A., Kadasheva A.B., Rotin D.L., Vetlova E.R.; FSBI "Research Institute of Neurosurgery named after. acad. N.N. Burdenko RAMS (magazine “Bulletin of the Russian Scientific Center of Radiology” No. 13) [read];

materials of the atlas “Tumors of the base of the skull” Dolgushin B.I., Matyakin E.G., Mudunov A.M.; ed. Practical medicine, 2011 [read]

article “Clinics, diagnosis and treatment of tumors of the skull base” by A.M. Mudunov, E.G. Matyakin; FSBI "National Medical Research Center of Oncology named after. N.N. Blokhin" of the Ministry of Health of Russia, Moscow (Materials of congresses and conferences "IX Russian Oncology Congress") [read]

© Laesus De Liro

Brain tumor- intracranial solid neoplasm, a tumor formed as a result of abnormal growth of cells in the brain or in the central spinal canal.

Brain tumors include all tumors inside the skull or in the central spinal canal. They are formed as a result of abnormal and uncontrolled cell division, usually not only in the brain itself, but also in lymphatic tissues, blood vessels, cranial nerves, meninges, skull bones, pituitary gland and pineal gland (epiphysis). Cells involved in tumor formation are neurons and glial cells, including astrocytes, oligodendrocytes and ependymal cells. Brain tumors can also be transmitted from a cancer located in another organ (metastatic tumors).

Primary (true) brain tumors are usually located in the posterior fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.

Sub/epidural hematoma

Severe headaches and very high blood pressure

Malignant hypertension

Acute severe headache

A definitive diagnosis of a brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either through brain biopsy or open surgery. Histological examination is important in determining appropriate treatment and correct prognosis. This examination is performed by a pathologist and typically consists of three stages: intraoperative examination of fresh tissue, preliminary microscopic examination of prepared tissue, and subsequent examination of prepared tissue after immunohistochemical staining or genetic analysis.

Pathology

Tumors have characteristics that make it possible to determine their malignancy and development trend, which allows doctors to determine a treatment plan.

Anaplasia or dedifferentiation - the transition of cells to an undifferentiated state, disruption of the process of cell differentiation and their orientation in relation to each other and to blood vessels - a characteristic of anaplastic tumor tissue. Anaplastic cells lose complete control of their normal functions and cellular structures become significantly compromised. Anaplastic cells often have an abnormally high nuclear-to-cytoplasmic ratio, and many are multinucleated. In addition, anaplastic cells usually have nuclei that are unnaturally shaped or large in size. Cells can become anaplastic in two ways: tumor cells can dedifferentiate and become anaplastic (dedifferentiation causes cells to lose their normal structure and function), or cancer stem cells can increase their ability to reproduce (eg, uncontrolled growth by failure of the differentiation process).

Atypia- a sign of cell abnormality that may indicate malignancy. The meaning of an anomaly depends largely on the context.

Neoplasia- uncontrolled cell division. Neoplasia in itself is not a problem. But the consequences of uncontrolled cell division lead to the fact that the volume of the tumor increases in size, this occurs in a limited space, the intracranial cavity, which quickly becomes problematic, since the tumor invades the space of the brain, moving it to the side. This leads to compression of brain tissue, increased intracranial pressure and destruction of brain parenchyma. Increased intracranial pressure (ICP) may be due to the direct effect of the tumor, increased blood volume, or increased cerebrospinal fluid volume, which in turn causes secondary symptoms.

Necrosis- premature cell death caused by external factors such as infections, toxins or injury. Necrotic cells send incorrect chemical signals that prevent phagocytes from processing dead cells, resulting in the accumulation of dead tissue, cell debris, and toxins in and around the dead cells.

Arterial and venous hypoxia, or deprivation of certain areas of the brain of sufficient oxygen supply, occurs when a tumor uses the blood vessels located around it for blood supply, and the tumor competes for nutrients with surrounding brain tissue.

In general, the neoplasm can produce metabolic products (eg, free radicals, altered electrolytes, neurotransmitters) and release and replenish cellular mediators (eg, cytokines) that disrupt normal parenchymal functions.

Classification

Secondary brain tumors

Secondary brain tumors are metastatic tumors that have invaded the inside of the skull from cancer that originated in other organs. This means that the cancer has developed in another organ or in other parts of the body and that the cancer cells have detached from the primary tumor and then entered the lymphatic system and blood vessels. These are the most common brain tumors. There are approximately 170,000 new cases annually in the United States. Cancer cells circulate in the blood and are deposited in the brain. There, these cells continue to grow and divide, becoming new tissue due to tumor invasion by the primary cancer. Secondary brain tumors are very common in the terminal phase in patients with incurable metastatic cancer. The most common types of cancer that cause secondary brain tumors are lung cancer, breast cancer, malignant melanoma, kidney cancer, and colon cancer (in descending order of frequency).

Secondary brain tumors are the most common cause of tumors in the intracranial cavity.

The bones of the skull can also be subject to neoplasms, which by their nature reduce the volume of the intracranial cavity, and can lead to brain damage.

By behavior

Brain tumors and intracranial tumors may be cancerous (malignant) or non-cancerous (benign). However, the definitions of malignant or benign growths are different from those typically used for other types of cancerous or non-cancerous growths in the body. For tumors in other parts of the body, three properties are used to differentiate benign from malignant tumors: benign tumors are self-limited, non-invasive, and do not form metastases. Characteristics of malignant tumors:

• Uncontrolled mitosis(growth due to abnormal cell division)
• Anaplasia(transition of cells into an undifferentiated state), the neoplasm cells have a clearly different appearance (differ in shape and size). Anaplastic cells are distinguished by pleomorphism. Cell nuclei may be extremely hyperchromatic (darkly colored) and enlarged. The nucleus can be the same size as the cytoplasm of the cell (the nuclear-cytoplasmic ratio can be 1:1, instead of the usual 1:4 or 1:6) Giant cells can be formed - larger in size than their neighbors. They either have one huge nucleus or contain several nuclei (syncytia). Anaplastic nuclei can be of variable and bizarre shape and size.
• Invasiveness(intrusion) or penetration. In the medical literature, these terms are used as equivalent synonyms. However, for the sake of clarity, this article is of the opinion that they mean slightly different things, this opinion does not go beyond the scope of this article:
• Invasion or invasiveness is the spatial expansion of a tumor due to uncontrolled mitosis, in the sense that the tumor invades the space occupied by adjacent tissues, thereby pushing other tissue aside, and ultimately compressing the tissue. Often invasive tumors are visible on tomograms as clearly defined.
• Infiltration is the spread of a tumor by microscopic tentacles that penetrate surrounding tissue (often making the contours of the tumor vague or diffuse), or the dispersal of tumor cells into tissue beyond the circumference of the tumor. This does not mean that infiltrative tumors do not take up a lot of space or do not compress surrounding tissue as they grow, but the penetration of the tumor makes its boundaries difficult to distinguish, and it is difficult to determine where the tumor ends and healthy tissue begins.
• Metastases- spread of the tumor to other places in the body through lymph or blood.

Of the above characteristics of malignant tumors, some elements do not apply to a primary brain tumor:

• Primary brain tumors rarely metastasize to other organs, and some forms of primary brain tumors may metastasize but do not spread beyond the intracranial cavity or central spinal canal. Due to the presence of the blood-brain barrier, cancer cells from the primary tumor cannot enter the bloodstream and settle elsewhere in the body. Anecdotal case reports of some brain tumors spreading beyond the central nervous system are occasionally published, such as bone metastases from glioblastoma.
• Primary brain tumors are usually invasive. Those. they will expand in space, invade the area occupied by other brain tissue and compress those brain tissues, but some of the most malignant primary brain tumors will invade surrounding tissue.

Of the numerous classification systems used for tumors of the central nervous system, the World Health Organization (WHO) commonly uses the classification system for astrocytomas. Founded in 1993 to eliminate confusion regarding diagnoses, the WHO system outlines a four-level histological classification for grading astrocytomas, which assigns a grade from 1 to 4, with 1 being the least aggressive and 4 being the most aggressive.

Brain tumor treatment

When a brain tumor is diagnosed, a medical panel is formed to evaluate the treatment options presented to the patient and family by the lead surgeon. Given the location of primary solid brain tumors, the option of “doing nothing” is generally not considered in most cases. Neurosurgeons take time to observe the evolution of the tumor before suggesting a treatment plan for the patient and his relatives. These different treatments are available depending on the type and location of the tumor and can be combined to increase the chances of saving your life:

• Surgery: complete or partial resection of the tumor to remove as many tumor cells as possible.
• Radiation therapy: the most commonly used method to treat brain tumors; the tumor is irradiated with beta rays, x-rays and gamma rays.
• Chemotherapy: is an option for cancer treatment, however, it is rarely used to treat brain tumors because the blood-brain barrier between the blood and brain prevents drugs from reaching cancer cells. Chemotherapy can be thought of as a poison that prevents the growth and division of all cells in the body, including cancer cells. Thus, patients undergoing chemotherapy experience significant side effects.
• Various experimental methods treatments have been described in clinical studies.

Survival for primary brain tumors depends on the type of tumor, age, performance status of the patient, extent of surgical removal of the tumor, and other case-specific factors.

Operation

The main and most desirable course of action described in the medical literature is surgical removal of the tumor (resection) by craniotomy. Minimally invasive techniques are being studied, but are far from common practice. The initial goal of the surgery is to remove as many tumor cells as possible. Complete removal is the best outcome, but cytoreduction of the tumor (removal followed by radiation or chemotherapy) is otherwise. In some cases, access to the tumor is impossible, and this prevents or makes surgery impossible.

Many meningiomas, with the exception of some tumors located at the base of the skull, can be successfully removed by surgery. Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity or base of the skull (trans-nasal, trans-sphenoid approach). Large pituitary adenomas require craniotomy (opening the skull) to be removed. Radiation therapy, including a stereotactic approach, is used for inoperable cases.

Several ongoing studies aimed at improving the surgical treatment of brain tumors use a method of labeling tumor cells with 5-aminolevulinic acid, which causes them to glow. Postoperative radiotherapy and chemotherapy are an integral part of the therapeutic standard for malignant tumors. Radiation therapy may also be used in cases of low-stage glioma when significant tumor removal cannot be achieved through surgery.

Anyone undergoing brain surgery may suffer from epileptic seizures. Seizures can range from none to severe tonic-clonic seizures. Prescribed treatment is aimed at minimizing or eliminating the occurrence of seizures.

Multiple metastatic tumors are usually treated with radiation therapy and chemotherapy rather than surgery, and the prognosis in such cases is determined by the condition of the primary tumor, but is usually poor.

Radiation therapy

The goal of radiation therapy is to selectively kill tumor cells while leaving healthy brain tissue unharmed. With standard external beam radiation therapy, complex treatment of the brain with doses of fractions of radiation is used. This process is repeated for a total of 10 to 30 procedures, depending on the type of tumor. This provides additional treatment for some patients with improved outcomes and increased survival rates.

Radiosurgery is a treatment method that uses computerized calculations to focus radiation on the tumor site while minimizing the radiation dose to the brain tissue surrounding the tumor. Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment for some tumors.

Radiation therapy may be used after, or in some cases, at the site of tumor resection. Forms of radiation therapy that are used for brain cancer include external beam radiation therapy, brachytherapy, and in more complex cases, stereotactic radiosurgery such as Gamma Knife, CyberKnife, or Novalis Tx radiosurgery.

Radiation therapy is the most common treatment for secondary brain tumors. The amount of radiation treatment depends on the size of the area of ​​the brain affected by the cancer. Standard external radiation with "whole brain radiation therapy" or "whole brain irradiation" may be offered if there is a risk that other secondary tumors may develop in the future. Stereotactic radiation therapy is usually recommended in cases involving fewer than three small secondary brain tumors.

In 2008, a study published by the University of Texas MD Anderson Cancer Center found that cancer patients who were treated with stereotactic radiosurgery (SRS) combined with whole-brain radiation therapy to treat metastatic brain tumors were at risk for learning problems and more than twice as many memory problems as patients treated with SRS alone.

Chemotherapy

Patients undergoing chemotherapy are given drugs designed to kill tumor cells. Although chemotherapy can improve overall survival in patients with the most malignant primary brain tumors, it does so in only about 20 percent of patients. Chemotherapy is often used in young children instead of radiation because radiation can have negative effects on the developing brain. The decision to give this treatment is based on the patient's general health, the type of tumor, and the extent of the cancer. The toxicity and side effects of many drugs, and the uncertain results of chemotherapy for brain tumors, make this treatment less preferable to surgery and radiation therapy.

Neuro-oncologists at the University of California, Los Angeles are publishing real-time survival data for patients diagnosed with glioblastoma multiforme. It is the only institution in the United States that maps how brain tumor patients perform on current therapy. They also show a list of chemotherapy drugs that are used to treat high stage glioma.

Other treatments

Shunt surgery is not used as a treatment for cancer, but as a way to relieve symptoms by reducing hydrocephalus due to blockage of the cerebrospinal fluid.

Researchers are currently studying a number of promising new treatments, including gene therapy, targeted radiation therapy, immunotherapy, and new chemotherapy drugs. A variety of new treatments are now available at research centers specializing in the treatment of brain tumors.

Forecasts

The prognosis depends on the type of cancer. Medulloblastoma has a good prognosis with chemotherapy, radiation therapy, and surgical resection. While with various glioblastomas, the average survival period is only 12 months, even with the use of aggressive chemotherapy and radiation therapy and surgery. Base brain gliomas have a poor prognosis, like any form of brain cancer, with most patients dying within one year, even with therapy, which usually consists of radiation to the tumor combined with corticosteroids. However, there is information that one type of centrally located base glioma may have an exceptional prognosis for long-term survival.

Glioblastoma multimorpha

Glioblastoma of the brain is the most dangerous and most common form of malignant brain tumors. Even with aggressive multimodal therapy consisting of radiation, chemotherapy and surgical resection, the average life expectancy is only 12-17 months. Standard therapy for glioblastoma consists of maximal surgical resection of the tumor, followed by radiation therapy two to four weeks after surgery to remove the cancerous tumor, followed by chemotherapy. Most patients with glioblastoma take corticosteroids, usually dexamethasone, to relieve symptoms during their illness. Experimental treatments include gamma knife radiosurgery, boron neutron capture therapy, and gene transplantation.

Oligodendrogliomas

Oligodendrogliomas are incurable but slowly progressive malignant brain tumors. They can be treated with surgical resection, chemotherapy and/or radiation therapy. When low-grade oligodendroglioma is suspected in selected patients, some neuro-oncologists opt for a course of watchful waiting and symptomatic therapy only. It has been established that tumors associated with mutations in chromosomes 1p or 19q are especially sensitive to chemotherapy drugs. One source reports that oligodendrogliomas are "among the most chemically sensitive of human solid tumors." With low-grade oligodendrogliomas, the average life expectancy reaches 16.7 years.

Epidemiology of brain tumors

The incidence of low-grade astrocytomas has not been shown to vary significantly by ethnicity. However, studies examining the incidence of CNS malignancies have shown some dependence on national origin. Because some high-grade tumors arise from less dangerous tumors, these trends are worth mentioning. In particular, the incidence of central nervous system tumors in the United States, Israel, and Nordic countries is relatively high, while Japan and Asian countries have lower rates. These differences likely reflect some biological differences as well as differences in pathological diagnosis and reporting.

Worldwide data on cancer incidence can be found on the WHO (World Health Organization) website and is also processed by IARC (World Agency for Research on Cancer), based in France.

Data on the incidence of brain cancer show significant differences between more and less developed countries. Less developed countries have a lower incidence of brain tumors. This may be explained by mortality from undiagnosed tumors. Patients in countries with extreme living conditions are not receiving a diagnosis, simply because they do not have access to the modern diagnostic tools needed to diagnose brain tumors. Also, many deaths there are due to the fact that it is not possible to take appropriate measures to treat the patient before the tumor becomes life-threatening. However, research suggests that certain forms of primary brain tumors are more common in certain populations.

United Kingdom

UK national statistics on newly diagnosed brain malignancies 2007 (absolute numbers and incidence per 100,000 people)

Units of measurement

All ages

Absolute numbers

Frequency per 100,000 inhabitants

USA

In the United States, 43,800 new cases of brain tumors were identified in 2005 (United States Central Brain Tumor Registry, United States Primary Brain Tumor Registry, Statistical Reports, 2005-2006), accounting for less than 1% of all cancer cases, 2.4% of all cancer deaths, and 20-25% of childhood cancers. Ultimately, it is estimated that there are 13,000 deaths per year in the United States alone as a result of brain tumors.

Developing countries

While cancer death rates are declining in the United States, children in developing countries are suffering due to the lack of a modern healthcare system. More than 60 percent of the world's children with cancer have little or no access to effective treatment, and their survival rate is significantly lower than in countries with developed health care systems.

Research

Vesicular stomatitis virus

In 2000, researchers at the University of Ottawa, led by John Bell, Ph.D., discovered that vesicular stomatitis virus, or VSV, could infect and kill cancer cells without affecting healthy cells when combined with interferon.

The initial discovery of the oncolytic properties of the virus applied to only a few types of cancer. Several independent studies have identified many other types that are susceptible to the virus, including glioblastoma cancer cells, which make up the majority of brain tumors.

In 2008, artificial engineered strains of VSV were obtained that had less cytotoxic effects on normal cells. This achievement allows the use of the virus without the simultaneous use of interferon. Therefore, the prescribed virus may be administered intravenously or through the olfactory nerve. In the study, a human brain tumor was implanted into the brains of mice.

Viral treatment research that has been conducted for several years has not found any other viruses as effective or specific as VSV mutant strains. Future studies will focus on the risks of such treatments before they are applied to humans.

Replication of retroviral vectors

Researchers at the University of Southern California, now located in Los Angeles, led by Professor Nori Kasahara, reported in 2001 the first successful application of replication using retroviral vectors to transduce cell lines derived from solid tumors. Based on this initial experience, researchers applied the technology to a natural cancer model, and in 2005, reported long-term survival for an experimental animal brain tumor model. Subsequently, in preparation for human clinical trials, this technology was further developed using the Toca 511 virus and Toca FC. This pathway is currently in the testing phase for the potential treatment of recurrent high-grade glioma, including glioblastoma and anaplastic astrocytoma.

Brain tumors in children

In the United States, about 2,000 children and adolescents under the age of 20 are diagnosed with malignant brain tumors every year. Relatively high incidence rates were reported in 1985-94 compared to 1975-83. There is some debate as to the reasons for this difference. One theory is that the trend is the result of improved diagnosis and reporting, since the jump occurred at the same time that magnetic resonance imaging became widely available, and there were no coincidental jumps in mortality rates. For central nervous system (CNS) cancer, the survival rate in children is approximately 60%. The extent depends on the type of cancer and the age at which the tumor occurred, with younger patients having a higher mortality rate.

In children under 2 years of age, about 70% of brain tumors are medulloblastomas, ependymomas, and low-grade gliomas. More rarely, and usually in infants, teratomas and atypical teratoid/rod tumors occur. Germ cell tumors, including teratomas, account for only 3% of childhood primary brain tumors, but incidence varies widely around the world.

Intracranial tumors develop from brain tissue, its membranes and skull bones. Tumors are divided into primary, originating from brain tissue, and secondary, metastatic.

Of the primary tumors, the most common are gliomas that develop from the medulla. They have infiltrating growth, lack clear boundaries, and can occur in all parts of the brain. Tumors called meningiomas (endotheliomas) arise from the meninges. Tumors have a benign course, slow growth, and sometimes reach significant sizes.

Secondary tumors are in most cases metastases of breast or lung cancer.

An intracranial tumor causes compression of local tissues and also affects the blood supply to the brain, compressing the ventricles of the brain, disrupting the outflow of cerebrospinal fluid from the cavities of the skull.

Clinical picture of intracranial tumor

The clinical picture of an intracranial tumor is determined by local and general symptoms. Common symptoms include headache, nausea, vomiting, dizziness, and nipple congestion.

Headache is often the initial symptom. The pain covers the entire head or is localized at the location of the tumor, sometimes reaching extreme intensity. Vomiting is not associated with food intake, it occurs in the morning, on an empty stomach, when the patient moves from a horizontal to a vertical position. At first, vision is not affected, but then, due to atrophy of the optic nerve, complete blindness can occur.

With tumors of the frontal lobes, one of the first symptoms is mental disturbance in the form of foolishness, euphoria, a tendency to flat jokes and inappropriate jokes. When the tumor is localized on the lower surface of the frontal lobe, the olfactory bulb is compressed and therefore the sense of smell is weakened or lost.

The symptoms are most clearly expressed when the tumor is localized in the anterior central gyrus. Active movements in the lower and upper limbs, neck, facial and other muscles are lost, depending on the location of the tumor. Initially, paresis and then paralysis are observed on the side opposite the tumor. Paralysis can affect the entire half of the body (hemiplegia).

When the tumor affects the temporal lobes, auditory hallucinations are observed. Tumors of the occipital region cause loss of visual fields in both eyes and visual hallucinations. Cerebellar tumors are characterized by loss of the ability to produce appropriate muscle contractions during movement and imbalance when walking.

Diagnosis of intracranial tumor

The diagnosis of an intracranial tumor can be made based on the medical history and a thorough neurological examination of the patient.

Many symptoms caused by intracranial masses reflect an enlargement of the tumor into a volume confined to the bones of the skull, normally occupied by the brain, blood, and cerebrospinal fluid (CSF). The nature and severity of these symptoms are determined by the location of the tumor and the rate of its growth. Although brain tissue can adapt to a slow-growing tumor, mass formations with a diameter of more than 3 cm compress the brain, its vessels and cerebrospinal fluid spaces. Compression increases as a result of swelling surrounding the tumor (vasogenic cerebral edema). As infiltration intensifies or displacement of normal brain structures increases, neurological symptoms increase, and as the tumor grows, areas of hemorrhage, necrosis, and cysts form. If the tumor blocks the normal flow of cerebrospinal fluid, hydrocephalus may occur.

Swelling or congestion in the area of ​​the optic nerve head occurs when the venous outflow and flow of axoplasm along the optic nerve are disrupted. Increased intracranial pressure caused by a mass in one hemisphere can lead to displacement of the medial temporal lobe (uncus) through the notch of the tentorium. When the hook protrudes from the tentorium cerebellum (herniation of the hook), the midbrain is displaced and the third cranial nerve is compressed. Clinical signs of unilateral third nerve palsy - a fixed, wide pupil, followed shortly by depression of consciousness, dilatation of the other pupil and hemiparesis on the opposite side - suggest herniation of the hook. A space-occupying process that is more centrally located supratentorially produces a less specific pattern called central herniation. In such a situation, as the diencephalon and upper parts of the midbrain are compressed, the patient develops depression of consciousness. Disturbances in the breathing rhythm of the Cheyne-Stokes type occur, but pupillary reactions persist for a long time, despite further deterioration of the patient’s condition.

If volumetric processes are localized in the cerebellum, herniation of the cerebellar tonsils into the foramen magnum occurs. When the tonsils are displaced downward, the medulla oblongata and part of the cervical spinal cord are subjected to compression and infarction. Disorders of cardiovascular regulation occur. Bradycardia and hypertension are followed by irregular breathing and then respiratory arrest. Small lesions in the posterior fossa can lead to early hydrocephalus as a result of blocking the outflow of CSF at the level of the fourth ventricle or aqueduct of Sylvius.

Symptoms of an intracranial tumor may appear in a patient with previously diagnosed systemic cancer or in the absence of evidence of malignant disease. Patients with an intracranial tumor usually present with one or more symptoms: 1) headache with or without signs of increased intracranial pressure; 2) generalized progressive deterioration of cognitive functions or impairment of specific neurological functions of speech and language, memory, gait; 3) epileptic seizures, beginning in adulthood, or an increase in the frequency and severity of previously observed epileptic activity; 4) focal neurological symptoms reflecting a specific anatomical location of the tumor, for example, with schwannoma (neuroma) of the auditory nerve in the cerebellopontine angle or meningioma of the olfactory fossa of the sellar and parasellar regions.

Headache is the first symptom in 50% of patients with brain tumors. Tension of the dura mater, blood vessels, and cranial nerves is the result of local compression, increased intracranial pressure, edema, and hydrocephalus. In most patients with supratentorial tumors, pain is reflected towards the tumor mass, and patients with tumors in the posterior fossa experience pain in the retroorbital, retroauricular and occipital regions. Vomiting, often without preceding nausea, indicates increased intracranial pressure and is especially common in patients with space-occupying processes of subtentorial localization.

Tumors of the frontal lobes can already reach significant sizes by the time the first neurological symptoms appear. Often these symptoms are nonspecific. Subtle progressive thinking disorders appear, intelligence slows down, business and professional qualities decrease, memory disorders or apathy, lethargy and drowsiness are observed. Spontaneity of thinking and action is lost. Urinary incontinence and gait instability appear. The development of true dysphasia and weakness in the limbs indicates an increase in the tumor and surrounding edema and their spread to the motor cortex and speech center in the frontoparietal region.

The tumor process, localized in the temporal lobe, is accompanied by personality changes that may be similar to psychotic disorders. A variety of auditory hallucinations, sudden mood changes, sleep disturbances, appetite, and sexual function begin to alternate with complex partial epileptic seizures and may be accompanied by defects in the upper quadrants of the visual fields on the side opposite to the tumor localization.

Tumor processes in the parieto-occipital localization are characterized by disturbances in higher cortical functions and vision. With tumors of the left parietal lobe, sensory aphasia with contralateral hemianopia is observed, and with tumors of the right parietal lobe, spatial disorientation, constructive apraxia and left-sided homonymous hemianopia are observed.

Diencephalon tumors often present with lack of pupillary response to light, inability to look up, and neuroendocrine disorders. Hydrocephalus, caused by a blockage of the cerebrospinal fluid passages at the level of the third ventricle, causes headaches. Syndromes of tumors of the diencephalon and posterior cranial fossa are discussed in more detail in the section of this chapter devoted to neoplasms of these localizations.

With lesions of the cerebellum and brain stem, paralysis of the cranial nerves, incoordination of the limbs and gait, and sometimes symptoms of hydrocephalus occur (see Chapter 352 for a description of the symptoms of damage to the cranial nerves).

Epileptic seizures as an initial symptom are observed in 20% of patients with brain tumors. Patients with epilepsy that first appeared after the age of 35 should be examined for the presence of a brain tumor.

Other groups of patients with newly diagnosed epileptic syndrome who are at high risk for brain neoplasms include patients with previously diagnosed systemic cancer, long-standing neurological diseases (including neuroectodermal lesions such as Recklinghausen disease and tuberous sclerosis), and acute and atypical psychiatric disorders. A careful history can help detect complex partial (temporal lobe) seizures and personality changes that predate diagnosis by several years. Sometimes the onset of the disease resembles a transient ischemic attack without residual symptoms, not accompanied by seizures, but, as a rule, the clinical features of a seizure provide sufficient information to determine the localization of the pathological process. Thus, the Jacksonian march of tonic-clonic convulsions indicates the localization of the tumor in the cortex of the frontal lobe, the sensory march - in the cortex of the sensory zone of the parietal lobe. For metastatic tumors that occupy the area of ​​gray matter transition to white matter, compared to primary tumors, the occurrence of acute symptoms is more common, manifesting itself within several days or weeks. An even more rapid development of neurological symptoms may be due to hemorrhage during metastases from tumors of the lungs, kidneys, thyroid gland, melanoma, and choriocarcinoma. In contrast, hemorrhage is rare in primary brain tumors, with the exception of malignant astrocytoma.

Brain tumors

Brain tumors are intracranial neoplasms, including both tumor lesions of cerebral tissues and nerves, membranes, blood vessels, and endocrine structures of the brain. They manifest themselves as focal symptoms, depending on the topic of the lesion, and general cerebral symptoms. The diagnostic algorithm includes examination by a neurologist and ophthalmologist, echo-EG, EEG, CT and MRI of the brain, MR angiography, etc. The most optimal is surgical treatment, supplemented with chemotherapy and radiotherapy if indicated. If this is not possible, palliative treatment is carried out.

Brain tumors

Brain tumors account for up to 6% of all neoplasms in the human body. Their frequency of occurrence ranges from 10 to 15 cases per 100 thousand people. Traditionally, cerebral tumors include all intracranial neoplasms - tumors of cerebral tissue and membranes, formations of cranial nerves, vascular tumors, neoplasms of lymphatic tissue and glandular structures (pituitary gland and pineal gland). In this regard, brain tumors are divided into intracerebral and extracerebral. The latter include neoplasms of the cerebral membranes and their choroid plexuses.

Brain tumors can develop at any age and can even be congenital. However, among children the incidence is lower, not exceeding 2.4 cases per 100 thousand children. Cerebral neoplasms can be primary, initially originating in the brain tissue, and secondary, metastatic, caused by the spread of tumor cells due to hemato- or lymphogenous dissemination. Secondary tumor lesions occur 5-10 times more often than primary tumors. Among the latter, the proportion of malignant tumors is at least 60%.

A distinctive feature of cerebral structures is their location in a limited intracranial space. For this reason, any volumetric formation of intracranial localization to one degree or another leads to compression of brain tissue and increased intracranial pressure. Thus, even brain tumors that are benign in nature, when they reach a certain size, have a malignant course and can lead to death. Taking this into account, the problem of early diagnosis and adequate timing of surgical treatment of cerebral tumors becomes particularly relevant for specialists in the field of neurology and neurosurgery.

Causes of brain tumor

The occurrence of cerebral neoplasms, as well as tumor processes of other localizations, is associated with exposure to radiation, various toxic substances, and significant environmental pollution. Children have a high incidence of congenital (embryonic) tumors, one of the causes of which may be a violation of the development of cerebral tissues in the prenatal period. Traumatic brain injury can serve as a provoking factor and activate a latent tumor process.

In some cases, brain tumors develop during radiation therapy for patients with other diseases. The risk of developing a cerebral tumor increases when undergoing immunosuppressive therapy, as well as in other groups of immunocompromised individuals (for example, with HIV infection and neuroAIDS). A predisposition to the occurrence of cerebral neoplasms is noted in certain hereditary diseases: Hippel-Lindau disease, tuberous sclerosis, phakomatoses, neurofibromatosis.

Classification of brain tumors

Among primary cerebral neoplasms, neuroectodermal tumors predominate, which are classified into tumors of astrocytic origin (astrocytoma, astroblastoma), oligodendroglial origin (oligodendroglioma, oligoastroglioma), ependymal origin (ependymoma, choroid plexus papilloma), pineal tumors (pineocytoma, pineoblastoma), neuron al (ganglioneuroblastoma, gangliocytoma), embryonal and poorly differentiated tumors (medulloblastoma, spongioblastoma, glioblastoma). Also distinguished are neoplasms of the pituitary gland (adenoma), tumors of the cranial nerves (neurofibroma, neurinoma), formations of the cerebral membranes (meningioma, xanthomatous neoplasms, melanotic tumors), cerebral lymphomas, vascular tumors (angioreticuloma, hemangioblastoma). Intracerebral cerebral tumors are classified according to localization into sub- and supratentorial, hemispheric, tumors of the middle structures and tumors of the base of the brain.

Metastatic brain tumors are diagnosed in 10-30% of cases of cancer affecting various organs. Up to 60% of secondary cerebral tumors are multiple in nature. The most common sources of metastases in men are lung cancer, colorectal cancer, kidney cancer, and in women - breast cancer, lung cancer, colorectal cancer and melanoma. About 85% of metastases occur in intracerebral tumors of the cerebral hemispheres. Metastases of uterine cancer, prostate cancer and malignant gastrointestinal tumors are usually localized in the posterior cranial fossa.

Brain tumor symptoms

An earlier manifestation of a cerebral tumor process is focal symptoms. It may have the following development mechanisms: chemical and physical effects on the surrounding cerebral tissue, damage to the wall of a cerebral vessel with hemorrhage, vascular occlusion by a metastatic embolus, hemorrhage into a metastasis, compression of the vessel with the development of ischemia, compression of the roots or trunks of the cranial nerves. Moreover, at first there are symptoms of local irritation of a certain cerebral area, and then a loss of its function occurs (neurological deficit).

As the tumor grows, compression, edema and ischemia spread first to tissues adjacent to the affected area, and then to more distant structures, causing the appearance of symptoms “in the neighborhood” and “at a distance,” respectively. General cerebral symptoms caused by intracranial hypertension and cerebral edema develop later. With a significant volume of cerebral tumor, a mass effect (displacement of the main brain structures) is possible with the development of dislocation syndrome - herniation of the cerebellum and medulla oblongata into the foramen magnum.

A local headache may be an early symptom of a tumor. It occurs due to irritation of receptors localized in the cranial nerves, venous sinuses, and walls of the meningeal vessels. Diffuse cephalgia is observed in 90% of cases of subtentorial neoplasms and in 77% of cases of supratentorial tumor processes. It has the character of a deep, quite intense and bursting pain, often paroxysmal.

Vomiting is usually a general cerebral symptom. Its main feature is the lack of connection with food intake. With a tumor of the cerebellum or fourth ventricle, it is associated with a direct effect on the vomiting center and may be the primary focal manifestation.

Systemic dizziness can occur in the form of a feeling of falling through, rotation of one’s own body or surrounding objects. During the period of manifestation of clinical manifestations, dizziness is considered as a focal symptom indicating tumor damage to the vestibulocochlear nerve, pons, cerebellum or fourth ventricle.

Motor disorders (pyramidal disorders) occur as primary tumor symptoms in 62% of patients. In other cases, they occur later due to the growth and spread of the tumor. The earliest manifestations of pyramidal insufficiency include increasing anisoreflexia of tendon reflexes from the extremities. Then muscle weakness (paresis) appears, accompanied by spasticity due to muscle hypertonicity.

Sensory disturbances mainly accompany pyramidal insufficiency. Clinically manifested in approximately a quarter of patients, in other cases they are detected only during a neurological examination. A disorder of muscle-joint sensation can be considered as a primary focal symptom.

Convulsive syndrome is more typical for supratentorial neoplasms. In 37% of patients with cerebral tumors, epileptic seizures are a manifest clinical symptom. The occurrence of absence seizures or generalized tonic-clonic seizures is more typical for tumors of midline localization; paroxysms of the type of Jacksonian epilepsy - for neoplasms located near the cerebral cortex. The nature of the aura of an epileptic attack often helps to determine the topic of the lesion. As the tumor grows, generalized seizures transform into partial ones. As intracranial hypertension progresses, as a rule, a decrease in epiactivity is observed.

Mental disorders during the period of manifestation occur in 15-20% of cases of cerebral tumors, mainly when they are located in the frontal lobe. Lack of initiative, sloppiness and apathy are typical for tumors of the pole of the frontal lobe. Euphoricity, complacency, causeless gaiety indicate damage to the base of the frontal lobe. In such cases, the progression of the tumor process is accompanied by an increase in aggressiveness, malice, and negativism. Visual hallucinations are characteristic of neoplasms located at the junction of the temporal and frontal lobes. Mental disorders in the form of progressive memory deterioration, impaired thinking and attention act as general cerebral symptoms, since they are caused by growing intracranial hypertension, tumor intoxication, and damage to associative tracts.

Congestive optic discs are diagnosed in half of the patients, more often in later stages, but in children they can serve as a debut symptom of the tumor. Due to increased intracranial pressure, transient blurred vision or “spots” may appear before the eyes. As the tumor progresses, there is an increasing deterioration in vision associated with atrophy of the optic nerves.

Changes in visual fields occur when the chiasm and optic tracts are damaged. In the first case, heteronymous hemianopsia is observed (loss of opposite halves of the visual fields), in the second - homonymous (loss of both right or both left halves in the visual fields).

Other symptoms may include hearing loss, sensorimotor aphasia, cerebellar ataxia, oculomotor disorders, olfactory, auditory and gustatory hallucinations, and autonomic dysfunction. When a brain tumor is localized in the hypothalamus or pituitary gland, hormonal disorders occur.

Diagnosis of a brain tumor

The initial examination of the patient includes assessment of the neurological status, examination by an ophthalmologist, echo-encephalography, and EEG. When examining the neurological status, the neurologist pays special attention to focal symptoms, which allows establishing a topical diagnosis. Ophthalmological examinations include testing of visual acuity, ophthalmoscopy and determination of visual fields (possibly using computer perimetry). Echo-EG can record expansion of the lateral ventricles, indicating intracranial hypertension, and displacement of the middle M-echo (with large supratentorial neoplasms with displacement of cerebral tissues). The EEG shows the presence of epiactivity in certain areas of the brain. If indicated, a consultation with an otoneurologist may be prescribed.

Suspicion of a brain mass is a clear indication for computed tomography or magnetic resonance imaging. A CT scan of the brain allows one to visualize a tumor formation, differentiate it from local edema of cerebral tissues, establish its size, identify the cystic part of the tumor (if any), calcifications, a necrosis zone, hemorrhage into the metastasis or tissue surrounding the tumor, and the presence of a mass effect. MRI of the brain complements CT and makes it possible to more accurately determine the spread of the tumor process and assess the involvement of border tissues in it. MRI is more effective in diagnosing tumors that do not accumulate contrast (for example, some gliomas of the brain), but is inferior to CT when it is necessary to visualize bone destructive changes and calcifications, to distinguish the tumor from the area of ​​perifocal edema.

In addition to standard MRI, MRI of brain vessels (study of vascularization of the tumor), functional MRI (mapping speech and motor areas), MR spectroscopy (analysis of metabolic abnormalities), MR thermography (monitoring thermal destruction of the tumor) can be used in the diagnosis of a brain tumor. PET of the brain makes it possible to determine the degree of malignancy of a brain tumor, identify tumor relapse, and map the main functional areas. SPECT using radiopharmaceuticals specific to cerebral tumors makes it possible to diagnose multifocal lesions, assess the malignancy and degree of vascularization of the tumor.

In some cases, stereotactic biopsy of a brain tumor is used. During surgical treatment, tumor tissue is collected intraoperatively for histological examination. Histology allows you to accurately verify a neoplasm and establish the level of differentiation of its cells, and therefore the degree of malignancy.

Brain tumor treatment

Conservative therapy for a brain tumor is carried out with the aim of reducing its pressure on cerebral tissue, reducing existing symptoms, and improving the patient’s quality of life. It may include painkillers (ketoprofen, morphine), antiemetic drugs (metoclopramide), sedatives and psychotropic drugs. To reduce brain swelling, glucocorticosteroids are prescribed. It should be understood that conservative therapy does not eliminate the root causes of the disease and can only have a temporary alleviating effect.

The most effective is surgical removal of the cerebral tumor. The surgical technique and access are determined by the location, size, type and extent of the tumor. The use of surgical microscopy allows for more radical removal of the tumor and minimizes injury to healthy tissue. For small tumors, stereotactic radiosurgery is possible. The use of the CyberKnife and Gamma Knife techniques is permissible for cerebral formations with a diameter of up to 3 cm. In case of severe hydrocephalus, shunt surgery can be performed (external ventricular drainage, ventriculoperitoneal shunting).

Radiation and chemotherapy can complement surgery or be a palliative treatment. In the postoperative period, radiation therapy is prescribed if the histology of the tumor tissue reveals signs of atypia. Chemotherapy is carried out with cytostatics selected taking into account the histological type of tumor and individual sensitivity.

Prognosis and prevention of brain tumors

Benign brain tumors of small size and localization accessible for surgical removal are prognostically favorable. However, many of them tend to recur, which may require repeated surgery, and each surgical intervention on the brain is associated with trauma to its tissues, leading to persistent neurological deficits. Tumors of a malignant nature, hard-to-reach localization, large size and metastatic nature have an unfavorable prognosis, since they cannot be radically removed. The prognosis also depends on the patient’s age and the general condition of his body. Old age and the presence of concomitant pathologies (heart failure, chronic renal failure, diabetes mellitus, etc.) complicate surgical treatment and worsen its results.

Primary prevention of cerebral tumors consists of excluding oncogenic environmental influences, early detection and radical treatment of malignant neoplasms of other organs to prevent their metastasis. Prevention of relapse includes avoiding sun exposure, head injuries, and taking biogenic stimulants.

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Intracranial tumors

Rice. 63. On a lateral projection of the skull, the arrow indicates the shadow of the calcified pineal gland.

Schuller points out that the pineal gland is usually projected on a lateral view 4.5 cm above the German horizontal and 1 cm posterior to the plane passing perpendicular to it through both external auditory canals. On the anterior sagittal image, the shadow of the calcified pineal gland is projected along the midline onto or above the frontal sinus area.

Rice. 64. On the X-ray of the skull in the lateral projection, the arrows indicate the shadows of the calcified vascular plexuses of the lateral ventricles.

In 1909, Schuller first pointed out that in the presence of intracranial tumors, there is often a displacement of calcified areas of the brain, which can be an important symptom indicating the location of the tumor. For example, when the pineal gland is displaced on a sagittal image to the left of the midline, the tumor is located in the right half of the brain, when it is displaced forward (in the lateral projection image) - posteriorly.

Rice. 65. On the radiograph in the anterior projection, the arrow indicates the shadow of the calcified falciform process.

For ophthalmologists, the calcification of the internal carotid artery, the shadow of which is projected onto the area of ​​the sella turcica in the form of a curved strip or tube, is of greatest importance (Fig. 66). Thiel and other authors associate calcification of the internal carotid artery with the so-called “pseudoglaucoma”, in which excavation of the optic nerve nipple is formed without increasing ophthalmotonus.

Rice. 66. On a targeted radiograph of the sella turcica, the arrow indicates the shadow of the calcified internal carotid artery.

As the work of one of the authors, L. Ya. Itsikson, showed, a calcified internal carotid artery is also radiologically detected very often in elderly people, but ophthalmoscopically, excavation of the optic nerve nipple is not observed in them.

Rice. 67. On a targeted radiograph of the sella turcica, the arrow indicates ossification of the petrosellar ligament (osteophyte).

Rice. 68. On a targeted radiograph of the sella turcica, a shadow of calcified intersphenoidal ligaments is visible. A single arrow indicates the anterior hole, a double arrow indicates the rear hole, and a triple arrow indicates the upper hole.

For the diagnosis of intracranial tumors, changes in the sella turcica are of exceptional importance. Kornblum found them in 64.6% of 446 cases of clinically tested brain tumors. Changes (primary or secondary) in the area of ​​the sella turcica become of no small importance for the ophthalmologist, since initially in many cases complaints about disturbances on the part of the visual analyzer come to the fore.

Rice. 69. On a targeted radiograph of the sella turcica, the arrow indicates the shadow of the calcified diaphragm.

Sometimes radiographs show a calcified diaphragm of the sella turcica, which, like a bridge, connects the anterior and posterior wedge-shaped processes (Fig. 69). The chiasma of the optic nerves lies at a certain angle directly on the diaphragm of the sella turcica. Some authors indicate that in most cases the chiasma does not lie directly on the diaphragm, but is located at some distance above it. There are three main types of position of the optic chiasm (Fig. 70).

Fig. 70. Diagram of the location of the chiasm in relation to the chiasmatic groove (according to Schaeffer).

a - location of the anterior part of the chiasm in the area of ​​the chiasmatic sulcus; b and c - the chiasma is located above the diaphragm; d - the chiasma is located above the back of the sella turcica.

1) anterior, when the opa is located in the area of ​​the chiasmatic groove (according to Schaeffer, occurs in 5% of cases);

2) average, when the chiasm is located above the diaphragm (91% of cases);

3) posterior, when the chiasm. located above the back of the sella turcica (4% of cases).

2) arteries pass above the middle of the chiasm;

3) the arteries are located asymmetrically (one above the optic nerve, the other above the chiasm).

Rice. 71. Sight radiograph of the sella turcica. The middle sphenoid process is indicated by an arrow.

The contours of the sella turcica are normally always smooth and clear (Fig. 72). When installed well, the saddle appears to be single-circuit. Sometimes, with insufficiently correct alignment or asymmetry of the skull, a double-contour image of the sella turcica is obtained, which is not a pathology if there are even, smooth contours and the absence of any changes indicating bone destruction. Three-circuitry speaks of a pathological process that subjected the saddle to destruction.

Rice. 72. Small size Turkish saddle.

D. G. Rokhlin notes that a zigzag or wavy line of the bottom of the sella indicates pathology, and in the presence of a malignant neoplasm, the contours will be clear. Fuzzy contours indicate a benign tumor. Very often, in the presence of an intrasellar tumor, there is blurred contours in the posterior part of the sellar floor at the border with its back. It should be noted that with a tower skull there is a depression in the anterior part of the sella turcica, which is normal for this skull shape. Defects and abnormalities observed in the area of ​​the fundus, dorsum sella and sphenoid processes are always characteristic of a pathological process.

Brain tumors: causes, manifestations, diagnosis, how to treat

The problem of malignant brain tumors continues to remain quite relevant and complex, despite advances in the field of diagnosis and treatment of tumors in general.

According to statistics, the incidence of brain tumors (neoplasia) is approximately 1.5%; they are more often recorded in children. In adults, the predominant age of those affected is years; men are slightly more often affected. In children, neoplasms of the central nervous system take second place in frequency, second only to leukemia (tumors of hematopoietic tissue), and the most common types are gliomas and congenital variants of neoplasia, while in adults, in addition to gliomas, vascular tumors form - meningiomas, and are also often found secondary, metastatic, nodes.

Like other malignant neoplasms, brain tumors are characterized by rapid growth, the absence of clear boundaries with the surrounding tissue, the ability to grow into the brain substance, damaging it, and also metastasis.

Certain types of cancer reach significant sizes in a matter of months, and the growth process is aggravated by the fact that they are located in a limited space of the skull, so complications and symptoms are always severe. As a rule, they do not extend beyond the cranial cavity and metastasize along the cerebrospinal fluid pathways within the head.

There are also benign tumors in the brain that grow slowly and do not metastasize. However, the concept of malignancy in relation to tumors of the central nervous system is very relative, which is associated with their growth in a small volume of the cranial cavity. In addition, many benign tumors do not have a clear border with the surrounding healthy tissue, which makes them difficult to remove without subsequent neurological damage. Any brain tumor, even benign, in one way or another causes compression of the nervous tissue, damage to vital nerve centers and a significant increase in intracranial pressure, and is therefore accompanied by severe symptoms and is fraught with adverse consequences. In this regard, even benign tumors often have a malignant course.

It is worth noting that the term “brain cancer” is not applicable to neoplasms from nervous tissue, since cancer, from the point of view of histogenesis (origin), is a tumor of epithelial cells. In the brain, the source of development of tumors is neuroglia - the main supporting “framework” for neurons, which also performs a trophic function (gliomas, glioblastomas), derivatives of mesenchyme, vascular walls, nerve sheaths, etc.

Causes of brain tumors

The exact causes of malignant brain tumors have not been established to date. The possibility of environmental influences, genetic abnormalities, changes in hormonal levels and metabolism, ionizing radiation cannot be ruled out, and the possible role of viral infections and injuries.

In children, in addition to the listed factors, disturbances during embryogenesis, that is, during the period of intrauterine development in the process of formation of nervous tissue, are important. When the normal movement of tissue primordia changes, fields of embryonic, immature cells are preserved, and prerequisites for the development of congenital, dysontogenetic tumors arise. As a rule, they appear at a very early age of the child.

Genetic abnormalities underlie familial (hereditary) forms of tumors of the nervous system, such as Recklinghausen disease, diffuse glioblastomatosis, etc.

Secondary, or metastatic, brain tumors are caused by tumors in other locations. Most often, lung, breast, and intestinal cancers metastasize this way. These tumors are not independent, therefore they are considered in the context of those neoplasias that were their source.

Many people are interested in the question: does using a mobile phone affect the possibility of developing cancer or brain tumors? To date, there is no convincing data proving this assumption, but research in this direction continues.

Types and features of classification of brain tumors

Brain tumors are a fairly large group of neoplasms, including both benign and malignant variants, differing in origin, location, clinical course and prognosis.

There is still no uniform classification; this is due to the diversity of tumors, the difficulties of their diagnosis and the different opinions of researchers regarding specific types of neoplasia.

Histogenetic classification, based on the identification of variants with a certain histological structure and degree of differentiation, has become more complete and accurate thanks to the capabilities of modern diagnostic methods, such as immunohistochemical, cytogenetic and molecular genetic. Using these techniques, it is possible to more reliably determine the source of origin of a particular neoplasm by searching for specific genetic characteristics and markers (proteins) characteristic of certain cells of the nervous tissue.

Based on the degree of maturity, the following are distinguished:

1. Benign tumors;
2. Malignant (highly or poorly differentiated).

Depending on the location of the tumor, there are:

• Intracerebral;
• Intraventricular;
• Extracerebral;
• Intermediate group (teratomas, embryonal tumors);
• An independent group (metastatic nodes, cysts, tumors of unknown origin, etc.).

Depending on histogenesis, it is customary to distinguish the following most common types of brain tumors:

1. Neuroepithelial (neuroectodermal) – originating directly from the brain substance and the most common;
2. Meningovascular – tumors of vascular origin, from the meninges;
3. Pituitary tumors (adenomas);
4. Tumors from mesenchymal derivatives;
5. Tumors of the cranial nerves;
6. Teratomas (arising as a result of embryogenesis disorders);
7. Secondary (metastatic) tumor nodes.

common tumors and their locations

Among benign brain tumors, the most commonly diagnosed tumor is meningioma, which is formed from the vessels of the pia mater and accounts for about 20% of all neoplasms growing within the skull. As a rule, meningioma occurs in adults and is an isolated node located on the basal (adjacent to the base of the skull) or convexital (outer) surface of the brain, less often in the cerebral ventricles. With timely detection and treatment, the prognosis is favorable, but if localized in the brain stem, the consequences can be unfavorable, since even with a small size, meningioma can compress nervous tissue and cause serious disorders.

Another common type of benign brain tumor (glioma) is the so-called astrocytoma, a slow-growing tumor found in all parts of the brain and most often affecting young people. Astrocytoma, despite its benign nature, often does not have a clear boundary with the surrounding nervous tissue, and can also grow diffusely (not as an isolated node), which creates significant difficulties in its surgical treatment. Other types of benign tumors are much less common.

appearance of various brain tumors

Among malignant neoplasms, the most common are glioblastomas and medulloblastomas.

Medulloblastoma is one of the most malignant brain tumors because it originates from the least mature cells - medulloblasts. As a rule, its cause is dysgenetic changes, that is, a violation of the displacement of embryonic rudiments in the prenatal period with the preservation of fields of immature embryonic cells in the brain tissue. In this regard, medulloblastoma is most often found in children, accounting for one fifth of all intracranial neoplasms in childhood. The primary location of the tumor is the cerebellar vermis.

Glioblastoma is the second most common tumor after astrocytoma and affects older people, mostly men. This tumor is capable of growing rapidly, often does not have clear boundaries with surrounding tissues, and is prone to the development of secondary changes - necrosis (death of tissue fragments), hemorrhages, cysts, and therefore has a motley appearance on the section. Outside the brain, its metastases are never detected, but rapid growth and damage to various parts of the brain can lead to the death of the patient in 2-3 months.

In addition to those listed, other, much rarer neoplasms (cerebral sarcoma, pigmented tumors, etc.) may also occur in the brain.

High-grade neoplasias are often characterized by low sensitivity to treatment (chemo- and radiation therapy, surgical removal), so the prognosis in such cases is always poor.

A special place is occupied by secondary, metastatic tumors. Most often, breast, lung, and kidney cancers metastasize this way. In this case, individual cells or their clusters are carried through the bloodstream into the brain and, settling in the microvasculature, give rise to the growth of a new node. As a rule, the histological structure of such metastases is similar to the structure of the primary tumor, that is, it is cancer formed by epithelial cells, but originating from another organ. Determining their relationship does not present significant difficulties. Metastases can be quite easily removed surgically, since a zone of softening of the nervous tissue forms around them, but this does not prevent the possibility of their growth in the future.

Features of the clinical course

Symptoms of a brain tumor are varied. There are no specific clinical signs indicating the presence of “cancer” or other neoplasm, and manifestations are caused not only by damage to a specific part of the brain, but also by increased intracranial pressure (ICP) and displacement of its structures.

All symptoms associated with the development of a tumor can be divided into several groups:

• General cerebral;
• Focal neurological symptoms;
• Dislocation syndrome.

General cerebral signs

General cerebral symptoms are associated with increased intracranial pressure due to the appearance of additional tissue volume in the cranial cavity, as well as irritation of the nerve endings of the brain, its membranes, and involvement of blood vessels in the pathological process. In most cases, there is a violation of the circulation of cerebrospinal fluid, which entails stretching of the ventricles of the brain, its swelling and, as a consequence, an increase in intracranial pressure.

The main and most common cerebral symptom is headache. It is constant, bursting in nature, and can intensify at night or in the morning, as well as with coughing and physical effort. Over time, as the tumor grows and the pressure inside the skull increases, its intensity increases. In addition to such diffuse intense pain, focal, boring or pulsating pain may also occur.

typical symptoms of a brain tumor

Other common signs of a brain tumor are vomiting, which occurs with the most severe headache, dizziness and blurred vision. Vomiting can be a consequence not only of intracranial hypertension, but also of direct irritation of the vomiting center with the growth of neoplasia in the medulla oblongata, cerebellum and the region of the fourth ventricle. In such cases, it will be one of the early symptoms of the disease. Frequent vomiting does not bring relief and causes significant suffering to the patient.

Dizziness is very characteristic of damage to the brain stem, frontal and temporal lobes.

With an increase in ICP, compression of the central retinal veins occurs, which carry venous blood away from the eyes, which is manifested by blurring and decreased visual acuity. Over time, optic disc atrophy may develop.

Among the general cerebral symptoms, convulsive seizures caused by irritation of nervous tissue and mental disorders are also distinguished. Mental disorders can be expressed in a tendency to depression or, conversely, euphoria, lack of criticism of one’s condition, memory loss, decreased intelligence, and sloppiness. Patients are capable of committing unmotivated and inappropriate actions, withdrawing into themselves and refusing communication, food, etc. Mental disorders manifest themselves very clearly when the frontal lobes of the cerebral hemispheres are damaged (the so-called “frontal psyche”).

Local neurological disorders

Focal neurological symptoms are associated with tumor damage to a specific part of the brain. The characteristic features are determined by the functions that this area performs. When a tumor grows in the frontal lobes, mental disorders, movement disorders, speech impairment, or even complete absence are possible.

1. Damage to the parietal lobe is often accompanied by loss of sensation and motor function. Such patients lose the ability to write, read, and count.
2. Tumors localized in the temporal lobe provoke disturbances in vision, hearing, smell, taste, visual and auditory hallucinations, as well as convulsions are possible.
3. When a tumor grows in the occipital lobe, the first signs will often be various disturbances in visual function in the form of loss of visual fields, the appearance of visual hallucinations, and disturbances in the sense of color.
4. Cerebellar tumors are accompanied by fairly characteristic symptoms. Early signs will almost always be vomiting and headache due to irritation of the vomiting center and intracranial hypertension. Since the cerebellum is responsible for coordination of movements, maintaining body posture in space, fine motor skills, etc., when it is damaged, changes in the motor sphere most often occur (impaired statics, coordination, spontaneous movements, muscle hypotonia, etc.).
5. A tumor of the brain stem is quite rare, and symptoms are mainly caused by damage to the cranial nerves (disorders in breathing, swallowing, internal organ function, vision, smell, etc.). Often, neoplasms of this localization, even if they are small in size and benign, pose a threat to the patient’s life.

Dislocation syndrome is associated with an increase in the volume of the tumor, compressing neighboring formations, which can lead to a displacement of brain structures relative to its axes. With a significant increase in ICP, the formation of so-called intracranial hernias occurs, when parts of the brain are wedged under the spurs of the dura mater or into the foramen magnum. Such conditions are fatal in some cases and therefore require urgent neurosurgical assistance.

The course of the disease depends not only on the localization of a particular neoplasm, but also on the degree of differentiation (maturity) of the cells that form it. Thus, low-grade (high-grade) tumors are characterized by rapid growth, rapid development of a clear clinical picture and a poor prognosis. Their treatment is difficult due to poor sensitivity to various methods of exposure. On the other hand, benign tumors, even small ones, localized in the brain stem, can lead to death in a short time.

Some of the symptoms described, in particular headache, dizziness, and decreased vision, occur quite often in many of us, but their presence should not be a reason to immediately suspect a brain tumor. Do not forget that neoplasms of such localization are quite rare, while migraines, osteochondrosis, vascular disorders, arterial hypertension and many other diseases are very, very common and give similar symptoms. If you have any complaints, you need to contact a specialist who will prescribe the full range of necessary examinations to exclude a brain tumor.

It is not customary to distinguish stages for brain tumors. Of much greater importance from the standpoint of the clinical course, response to treatment and prognosis is the identification of degrees of malignancy. Simplified, they can be represented as follows:

• I degree – benign neoplasms;
• Grade II – includes tumors of undetermined or low-grade malignancy (well-differentiated neoplasms); such tumors may recur, and the degree of their differentiation (maturity) may decrease;
• Grade III – highly malignant neoplasia, which requires radiation and chemotherapy;
• Grade IV characterizes low-grade, highly malignant neoplasms that are difficult to treat due to poor sensitivity and have a very unfavorable prognosis.

From examination to diagnosis

Since early symptoms of a tumor can often be very nonspecific, additional examinations are necessary to confirm or refute suspicions. Modern diagnostic procedures and neuroimaging methods make it possible to identify even small tumors in a variety of parts of the brain.

The main methods for diagnosing brain tumors are:

1. Angiography;
2. Electroencephalography;
3. Radioisotope scanning;
4. X-ray of the skull;
5. Lumbar puncture;
6. Fundus examination;
7. Biopsy.

If symptoms appear that indicate the possibility of tumor growth, you should consult a doctor. The neurologist will examine you, ask in detail about the nature of the complaints, conduct a neurological examination and prescribe the necessary examinations.

Contrast-enhanced MRI can rightfully be considered the “gold standard” for diagnosing brain tumors, which makes it possible to detect various neoplasms, clarify their location, size, nature of changes in surrounding tissues, the presence of compression of the ventricular system, etc.

MRI (left) and CT (right) in the diagnosis of brain tumors

If there are contraindications to MRI (pacemakers, installed metal structures, heavy patient weight, etc.), as well as in the absence of the possibility of conducting such a study, diagnosis using computed tomography, with or without the introduction of contrast, is possible.

difference between a primary brain tumor (well-differentiated glioma) - on the left in the figure, and metastases to the brain - on the right in the figure, MRI image

X-ray of the skull makes it possible to detect the presence of foci of destruction (destruction) of bone tissue under the influence of a tumor or, conversely, its compaction; change in vascular pattern.

With the help of pneumoencephalography (x-ray examination with the introduction of air or other gases), it is possible to establish the state of the ventricular system of the brain and judge the violation of liquorodynamics (circulation of the cerebrospinal fluid).

Electroencephalography is indicated to detect areas of increased brain activity (especially in the presence of seizures), which usually correspond to the site of tumor growth.

It is also possible to use radioisotope methods, which make it possible to determine with sufficient accuracy not only the location of the tumor, but also some of its properties.

A spinal puncture followed by examination of the cerebrospinal fluid makes it possible to measure the level of its pressure, which often increases with intracranial neoplasms. The composition of the cerebrospinal fluid also changes towards an increase in the content of protein and cellular elements in it.

Angiography allows you to determine changes in the vascular bed of the brain, the characteristics and intensity of blood supply in the tumor itself.

In case of brain tumors, an ophthalmologist will determine changes in visual acuity and other disturbances, and examination of the fundus will help identify the presence of congestion and atrophy of the optic nerve head.

If difficulties arise in instrumental diagnosis, in complex and unclear cases, a biopsy is possible - taking a fragment of the tumor for histological examination. This method makes it possible to establish the type of neoplasm and the degree of its differentiation (malignancy). If necessary, it can be supplemented by immunohistochemical research, which allows one to detect specific proteins characteristic of certain cells of the nervous tissue (for example, protein S 100 and NSE).

If metastatic brain damage is suspected, it is necessary to establish the source of the tumor, that is, the possibility of cancer growth in the breast, lungs, etc. To do this, other complaints of the patient are clarified, X-ray of the lungs, ultrasound of the abdominal organs, FGDS, mammography, etc. are performed, depending on the expected diagnosis.

In addition to the described instrumental diagnostic methods, changes can also be detected in a blood test (increased ESR, leukocytosis, anemia, etc.).

Treatment and prognosis for brain tumors

After establishing an accurate diagnosis, depending on the type of tumor, its location, size and sensitivity to a specific effect, the doctor chooses the most optimal treatment method or a combination of both.

Main directions of therapy:

The result is largely determined by the location of tumor growth, size, the nature of its influence on the surrounding nervous tissue, but even more so by the degree of differentiation (malignancy).

The main and, as a rule, initial method of treatment is surgical removal of tumor tissue. This is the most radical and often the most effective way to get rid of neoplasia. Surgeries to remove tumors are performed by neurosurgeons. Since the manipulation removes not only the tumor itself, but also part of the periphery that surrounds it, it is important to preserve functionally active nerve tissue if possible. Surgical treatment is not carried out only when any intervention is dangerous to the patient’s life due to a serious condition, and also when the tumor is located in such a way that it is inaccessible to the surgeon’s knife or its removal can lead to dangerous damage to nearby parts (brain stem, subcortical nodes). If possible, the tumor is partially removed.

With surgical treatment of a tumor, it becomes possible to subsequently conduct a histological examination of its tissue to determine the degree of differentiation. This is important for further prescribing chemotherapy and radiation therapy.

After the operation, which is one of the stages of complex treatment of patients with brain tumors, radiation treatment and/or chemotherapy is prescribed.

Radiation therapy involves the impact of ionizing radiation on the site of tumor growth (the bed after its removal), the entire brain or spinal cord. If surgery is not possible, this method becomes the main one. Also, irradiation makes it possible to eliminate the remnants of tumor tissue after non-radical surgical removal. This type of treatment is prescribed by a radiation oncologist.

Recently, the use of so-called stereotactic radiosurgery (gamma knife) has become increasingly popular. The method consists of local exposure to high-intensity gamma rays, which makes it possible to remove deep-lying tumors that are inaccessible to surgical treatment. This method is also effective for some benign tumors, such as meningiomas.

Chemotherapy means the prescription of antitumor drugs to which this type of neoplasia is sensitive. Sometimes this method becomes the main one (for an inoperable tumor), but more often it complements the first two. It is possible to use drugs that reach the tumor growth zone through the bloodstream, as well as to administer them directly into the tumor bed or liquor system, which reduces the likelihood of side effects. Since this treatment is quite aggressive, and many drugs are toxic, it is also necessary to prescribe hepatoprotectors and vitamin-mineral complexes.

At all stages, symptomatic therapy is carried out to alleviate the condition of patients. For this purpose, painkillers, antiemetics, etc. are prescribed.

If dislocation syndrome develops, the patient requires urgent surgery aimed at decompression - reducing intracranial pressure. This may be a puncture of the cerebral ventricles to remove excess cerebrospinal fluid. Subsequently, the patient is indicated for elective surgery to eliminate the tumor.

It is important to note that treatment with folk remedies, untested methods, various dietary supplements, with the help of psychics or hypnosis is unacceptable in the case of brain tumors and can lead to the rapid death of the patient or the impossibility of surgical removal due to lost time and rapid progression of the disease. In such situations, you should not hope for a miracle or luck, since only traditional medicine can give a chance, if not for a complete cure, then for prolonging life and improving its quality.

The prognosis for benign brain tumors is good, but for malignant ones, it is most often unfavorable. It is important to establish a correct diagnosis in a timely manner, since the key to successful treatment is its early start.

With correct diagnosis of benign tumors and adequate treatment, patients live for many years after its removal.

To a large extent, the outcome is determined by the degree of tumor differentiation. With highly malignant variants, therapy can only prolong the time before relapse or progression of tumor growth, so the patient has a rather short period of time to live. For certain types of neoplasia, life expectancy is several months, even with intensive treatment.

After courses of therapy, patients are subject to constant monitoring and regular MRI monitoring of the brain. Immediately after treatment, additional tomography is performed to monitor the effectiveness of the measures taken. For highly differentiated and benign tumors, MRI must be performed every six months during the first year after surgery, and annually thereafter. For highly malignant tumors - more often, once every three months in the first year and then every six months.

If any symptoms occur, you should immediately consult a doctor. These preventive measures will allow you to avoid or promptly diagnose a recurrence of a brain tumor.

Flax. dept. Publishing house "Medgiz", Leningrad, 1961

Given with some abbreviations

The publication is intended for a wide range of practitioners - neurologists and neurosurgeons. It aims to help them recognize one of the most complex and difficult to diagnose diseases, which are brain tumors. The monograph summarizes the author's extensive clinical material and concerns mainly the most common tumors of the brain and its membranes.

Particular attention is paid to the analysis of some difficulties and errors in the diagnosis of intracranial neoplasms. Here a brief description of the main clinical syndromes of tumors is given, a number of statements are made that have a certain significance for topical diagnosis, and some new data concerning the clinical picture of brain tumors in general are presented. The book by N. A. Popov will contribute to the development of clinical thinking of practical doctors at the patient’s bedside and thereby contribute to an earlier and more accurate diagnosis of intracranial tumors.

PREFACE

N. A. Popov’s monograph, dedicated to the clinical picture of brain tumors, mainly to the analysis of difficulties and errors in their diagnosis, is an original study and undoubtedly deserves the attention of neuropathologists and neurosurgeons interested in issues of neuro-oncology. The main goal and task of the essay set by the author, naturally, determined both the original plan for constructing the monograph and the entire system of presentation. It can serve as a valuable addition to the systematic description of the study of the clinical picture of intracranial tumors.

A retrospective analysis of difficulties and errors in recognizing brain tumors has a certain educational value and is very important for the further development of topical diagnostics. Particularly fruitful in this regard seems to us to be a critical analysis of individual observations collected by the same researcher and personally followed up by him. This issue is rarely brought up on the pages of our press, and there are no special monographs devoted to this problem in the domestic literature. Therefore, the work undertaken by the author and well documented deserves high praise.

Although we are talking here about individual observations, taken together they can serve as good examples of the most common difficulties and errors in recognizing brain tumors. The reasons for these difficulties are sufficiently substantiated and represent objectively existing factors that have to be constantly encountered in practice. The considerations expressed by the author seem quite evidential and often very instructive.

Of course, not all the examples given from this point of view are equally demonstrative - this can hardly be required from this kind of research: personal character in assessing the observed facts determines both the train of thought and the conclusions to which the author comes in each individual case. However, in all the described observations there are certain features that characterize the particularities of the clinical picture of a given patient and may cause difficulties and diagnostic errors.

What has been said does not exhaust the significance of N. A. Popov’s monograph. The reader will also find here a lot of valuable and new information regarding the clinic of brain tumors in general, based on a large amount of factual material. A number of provisions expressed by the author are of undoubted importance for topical diagnosis. The introductions that precede each chapter are a brief description of the most important clinical symptoms of a given localization, reflecting to a certain extent the personal experience of the author. Based on his own research, he illuminates some of the problems of the brain tumor clinic in more detail. All this further increases the educational value of the monograph.

The author’s main idea was to highlight the importance of clinical neurological diagnostics; however, he, naturally, widely used, whenever possible, auxiliary research methods, including isotope encephalography. N. A. Popov’s book will undoubtedly benefit practitioners, will contribute to the development of their clinical thinking at the patient’s bedside and thereby contribute to earlier and more accurate recognition of intracranial tumors.

Corresponding member USSR Academy of Medical Sciences, honorable. activities science prof. I. Razdolsky

Supratentorial tumors