1. Brain SOL

2. Brain SOL Traumatic Subdural haematoma Extradural haematoma Vascular
Intracerebral haematoma
Infective
Cerebral abscess ;pyogenic, Toxoplasma
Tuberculoma
Cysticercosis
Hydatid cyst
Schistomiasis

3. Brain SOL Inflammatory Sarcoid mass Neoplastic
Cerebral neoplasms (benign or malignant )
Other
Embryonic dysplastic lesions e.g. craniopharyngioma &hamartomas
Arachnoid cyst

4. Account for 2% of all deaths The majority are metastatic
CNS tumours
Primary or Secondary
Account for 2% of all deaths
The majority are metastatic
Meningeomas account for 20 %of all intracranial tumours

5. Benign intracranial tumours
Age
Common site
Histologic type
Adulthood
Corticaldura,Para-sagittal, Sphenoidal ridge,Suprasellar,
Olfactory groove
Meningeoma
Acoustic neuroma
Neurofibroma
Childhood / Adolescence
Suprasellar
Craniopharyngioma
Pituitary fossa
Pituitary adenoma
Any age
Third ventricle
Colloid cyst
Childhood(teratoma)
Adulthood(germ cells)
Quadrigeminal cistern
Pineal tumors

8. Malignant intracranial tumours
Age
Common site
Histologic type
Adulthood
Childhood /Adulthood
Cerebral hemisphere
Cerebellum
Brainstem
Glioma
Oligodendroglioma
Childhood
Posterior fossa
Medulloblastoma
Childhood /Adolescence
Ependymoma
Cerebral Lymphoma

9. Even malignant tumours don’t metastasize outside the CNS

10. Secondaries (metastases)
Usually located in the white matter of cerebral or cerebellar hemispheres;common sources are bronchus ,breast &gastrointestinal tract.

11. CLINICAL FEATURES
Insidious Onset = May be acute with cystic degeneration, hemorrhage or with seizures.
Progressive course.
Space- occupying effect
Site of the tumor
False localizing signs

12. Space occupying effect Raised intracranial pressure
HEADACHE: Non specific;dull aching, eventually in most patients, more severe in early morning in % , aggravated by cough, sneezing, straining &change of posture (bending,lying ).
It is ipsilateral to supratentorial tumors in 80% of cases

13. Space occupying effect
Nausea &vomiting
Seizures : more if tumor in ant. Cranium e.g. more than 50% of frontal lobe tumours have seizures ;generalized or partial .
Papilloedema : more in infratentorial tumours, leading to transient visual obscurations.
Altered mentation.

14. SITE OF TUMOR FOCAL SIGNS &SYMPTOMS
Frontal lobe : Altered mood &behavior, contra. Motor deficit, incontinence,primitive reflexes
Parietal lobe : Sensory s.&s. may predominate, contra. Visual field &motor deficit
Non dominant parietal l. :sensory or visual inattention, dressing apraxia
Temporal lobe : Wernicke aphasia, sup. Quadrantanopia, temporal lobe epilepsy
Occipital lobe : visual field abnormality

15. FALSE LOCALIZING SIGNS
Pupillary dilatation.
6th cranial nerve palsy(unilateral or bilateral).
Hemiparesis (ipsilateral to the lesion ).
Bilateral extensor plantar responses.

16. The rise in intracranial pressure from a mass lesion is not usually uniform within the cerebral substance and alterations in pressure relationships within the skull may lead to displacement of parts of the brain between its various compartments. Downward displacement of the temporal lobes through the tentorium due to a large hemisphere mass may cause 'temporal coning
This may stretch the 3rd and/or 6th cranial nerves, or cause pressure on the contralateral cerebral peduncle (causing ipsilateral upper motor neuron signs).

17. Downward movement of the cerebellar tonsils through the foramen magnum may compress the medulla-(tonsillar coning)
This coning may result in brain-stem haemorrhage and/or acute obstruction of the CSF pathways. As coning progresses, the patient may adopt a decerebrate posture and, unless rapidly treated, death almost invariably ensues. The process may be acutely accelerated if the pressure dynamics are suddenly disturbed by lumbar puncture

18. INVESTIGATIONS Plain X Ray ; Signs of raised ICP, Calcification…
EEG : Focal slowing
CT Scan ,MRI &MRA

20. TREATMENT Reduce ICP : Osmotic diuretics, Steroids
Often required when surgery is not possible or when life is threatened.
Dexamethasone mg 12-hourly orally or by injection ;a striking improvement in consciousness is often produced &focal deficits may regress.
Mannitol 0.25 – 1 mg /Kg /Dose IVI.

21. Surgery Mainstay of treatment
Only partial excision may be possible if the the tumour is inaccesible or its removal is likely to cause unacceptable damage.
Biopsy should be considered even if the tumour is not removable ?prognosis &management.
Meningeomas,acoustic neuromas &pituitary adenomas.

22. Radiotherapy &Chemotherapy
Marginal effect on survival in metastases &malignant gliomas.
Combined therapy has improved prognosis in medulloblastomas in children.
Radiotherapy reduces the risk of recurrence of pituitary adenoma after surgery.
Ependymomas,some pineal tumours &low gradegliomas in children &young adults are often radiosensitive.

23. Prognosis For benign tumours is good if removed completely.
Ependymomas &Medulloblastomas may recur with seeding via the CSF.
Oligodendrogliomas may transform to more malignant form ---- glioma .
Related to histologic grade ;
G1&2 may survive for years
G 4 –only 20 %survive for 1 year.

24. Meningiomas
Arise from the dura mater and are nearly always benign, well-demarcated lesions that displace rather than invade the adjacent neural tissue as they grow.
These mesodermal tumors most often become clinically evident between the ages of 40 and 50.
They are diagnosed by MRI or CT scanning which reveals marked, homogeneous contrast enhancement Meningiomas tend to appear in certain classic locations with corresponding typical neurological manifestations. They often grow very slowly and are not uncommonly discovered as an incidental radiological finding. The indications for treatment must then be carefully considered: resection may be desirable in younger patients, but unnecessary in older ones.

25. للاطلاع

26. Common sites of meningiomas, and associated clinical features
Special features
course
Most common initial manifestations
Site
The frontal branch of the temporal artery may be enlarged
Epilepsy,personality changes,possible involvement of optic nerve
Anosmia
Olfactory groove
Hemiparesis
Epileptic seizures
Convexity
Rarely causes hemiparesis
Lower limb paresis;sometimes bilateral babinski sign
Parasagittal &falx
Lateral tumors may be evident as temporal hyperostosis
Exophthalmus,
hemiparesis
Visual disturbances(when medially located adjacent to optic nerve
Sphenoidal wing

27. Common sites of meningiomas, and associated clinical features
Special features
Course
Most common initial manifestation
Site
Progressive visual field defect
Visual disturbances,pale optic disc
Tuberculum sellae
Diff.diagnosis
Acoustic neuroma
facial&5th nerve deficit
Brainstem compression
Deafness,vertigo
Cerebellopontine angle
Lower cranial n.palsy
Spastic quadriparesis,dys-
phasia,dysarthria
Foramen magnum
Often found in trigone
Progressive hydrocephalus
Intermittent headaches,vomiting
Intraventricular

28. Meningioma of the left cerebral convexity

29. Falx meningioma

30. Sphenoid wing meningioma

31. THANK YOU