ODESSA NATIONAL MEDICAL UNIVERSITY

Department of neurology and neurosurgery

Methodological aid of the practical class for students on the theme

№3:

Tumors of the brain.

Classification. Clinic. Diagnosis. Patophysiological mechanisms of formation
hypertension syndrome. General and focal signs. Pathogenesis of primary and
secondary symptoms in brain tumors. Value subsidiary surveys (Ophthalmological
examination craniogray, ultrasound, EhoEH, EEG, pneumoencefalografy,
angiography, computed tomography, MRI, OFEKT) in the diagnosis of brain tumors.
Principles of surgical treatment of brain tumors based on hystostructure and
localization. Radical and palliative operations, their principles. The combined radio-
and chemo- treatment of brain tumors.Emergency assistance with syndrome of acute
intracranial hypertension and dislocation syndromes. Rehabilitation and
readaptation of patients after surgery on the brain tumor. Significance of bad habits
in the appearance of volume of brain lesions.
(V course of medical faculty)
Approved
At a methodological meeting of the department

31/08/2020.
Protokol № 1

Head of the department ​Son A.S.

Odessa – 2020
​
1. The THEME of the class: Classification. Clinic. Diagnosis. Patophysiological
mechanisms of formation hypertension syndrome. General and focal signs.
Pathogenesis of primary and secondary symptoms in brain tumors. Value subsidiary
surveys (Ophthalmological examination craniogray, ultrasound, EhoEH, EEG,
pneumoencefalografy, angiography, computed tomography, MRI, OFEKT) in the
diagnosis of brain tumors. Principles of surgical treatment of brain tumors based on
hystostructure and localization. Radical and palliative operations, their principles.
The combined radio- and chemo- treatment of brain tumors.Emergency assistance
with syndrome of acute intracranial hypertension and dislocation syndromes.
 Rehabilitation and readaptation of patients after surgery on the brain tumor.
Significance of bad habits in the appearance of volume of brain lesions
4 hours

2. Importance of the THEME: Tumours of the brain constitute 9 % of the general number of
all human neoplasms and take the fifth place among tumours of other localizations. One case of the
brain tumour is registered annually per 15-20 thousand people. Early diagnostics of the brain
tumour provides successful in treatment.
3.1. The practical aims: To give the students an opportunity to consider the basic clinical
signs of the brain tumours at the bed side of the patient. They can to consider general brain and
focal symptoms on the example of the patients with brain tumour. To learn diagnostic signs of
auxiliary methods of inspection in tumours of the brain. To consider the order of making and
formulation of the diagnosis. Surgery of tumours of the brain. Radical and palliative operations. The
combined treatment of malignant tumours.
3.3. The EDUCATIONAL AIMS: are connected with formation neurooncologic alertness
and feelings of great responsibility for health of the patient and his life in the students.
4. Materials of independent preparation (interdisciplinary integration)

DISCIPLINES TO KNOW TO BE ABLE

Nervous diseases General neurology, methods of
examination of the neurologic patient,
specific neurology
Oncology Clinical, histopathological
classification of tumours of the brain,
histologic types of tumours, surgical
classification
Radiology Craniographycs signs of hypertension
- liquor syndrome
To carry out the examination of the
neurologic patient.
To analyze general brain and local
symptoms
To inspect neurooncologic patient
To consider X-ray images of the patient
with brain tumour

5. The contents of the theme

Clinical classification of intracranial tumours
Localization of tumours
Supratentorial Subtentorial

Hemisphere Midline Adults Children

glioblastoma adenoma of a Angioblastoma ependymoma
hypophysis
astrocytoma Cranyopharyngioma Metastases glioma of the brain
stem
​
oligodendroglioma Pineal tumour Shwanoma of VIII astrocytoma of a
nerve cerebellum
meningioma colloidal cyst meningioma medulloblastoma
metastases

Clinical groups of neurooncological patients

Clinical group Degrees of size of the primary The fact of metastases
malignancy tumour
1А G1 T1 М0
1В G1 Т 2, Т3 М0
11А G2 Т1 М0
11В G2 Т2, Т3 М0
111А G3 Т1 М0
111В G3 Т2, Т3 М0
1Y G1, G2, G3, G4 Any Т М0, М1
 2. A place of carrying out the class a class-room, wards, diagnostic consultation rooms.
3. Duration of the class: 180 minutes.

Control questions:
1) Principles of classification of tumours of the brain.
2) Possibilities of clinical and additional methods of investigation while making the diagnosis of the
tumour of the brain.
3) The indication and contra-indication to application of auxiliary methods of investigation.
4) General brains and focal symptoms depending on localization and histostructure of tumours.
5) Pathogenetic mechanisms of development of hypertension - liquor syndrome. A role of auxiliary
methods of investigation.
6) The indication and contra-indication to carrying out X-ray contrast methods of examination.
Diagnostic importance of AG, VG, PEG, CT-SCAN, MRI.
8) Clinical symptoms of tumours of different localization.
9) The indication and contra-indication to a surgery of tumours of the brain.
10) The indication to palliative operations.
11) Methods of rehabilitation of patients after removal of the tumour of the brain.
1) 12) To know and posses principles of ethics and deontology in examination of patients with the
tumour of the brain.Classification of tumours of the brain in dependence on localization.
2) Classification of tumours of the brain in dependence on their histostructure.
3) What are the main clinical symptoms of tumours of the brain?
4) What pathophysiological mechanisms promote development of a hypertension syndrome?
5) Name the main clinical signs of a hypertension syndrome.
6) What causes primary and secondary focal symptoms in tumours of the brain?
7) What auxiliary method of investigation are applied in diagnostics of the tumour of the brain?
8) Name craniographic signs of the tumour of the brain?
9) What changes on the eye fundus can be observed in tumours of the brain?
10) What contrast investigation methods are applied in diagnostics of tumours of the brain?
11) What are the basis of rehabilitation and readaptation of the patients operated the tumour of the
brain?
12) What are the most frequent histobiologic kinds of tumours of the brain?
13) What is the sequence of application of auxiliary methods of diagnostics on suspicion of a
tumour of the brain?
14) What is it necessary to do for improvement of the condition of the patient with posterior cranial
fossa tumour when a syndrome of tonsil wedge of the cerebellum in the occipital-cervical dural
infundibulum?
​
15) Count kinds of treatment of tumours of the brain?
16) In what cases are the patients indicated palliative operations.
17) What methods are used for a rehabilitation of patients after removal of tumour of the brain?
6. Materials of methodological maintenance of the class.
Situational TASKS FOR CHECKING THE LEVEL OF KNOWLEDGE OF
STUDENTS WITH STANDARD ANSWERS.

№ 1. The patient of 34 years old had disorder of the menstrual cycle, and in a year there has
come amenorrhea which was regarded by doctors as an early climax. Then sight reduced, the patient
was treated at in- and out-patient departments for 2 years, but sight was progressively reducing. In 2
years visual acuity on the right eye was 0.03, left 0.02, at the expense of primary atrophy of the
optic nerves. Moderate headaches which worsened in the morning have developed. It is necessary to
make the preliminary diagnosis and to define the plan of examination.
ANSWER. The preliminary diagnosis: a tumour in the hypophysis area. With the greatest
probability of adenoma of the hypophysis. For specification of the diagnosis ophthalmologic study
is indicated, with specification of the field of vision, carrying out of target roentgenogram of the
turkish saddle. Echoencephalography, EEG, RHEOENCEPHALOGRAPHY, CT-SCAN.

№ 2. The patient of 62 years old developed, the limited immovable swelling 4х4 cm 2
months ago which was firmly adherent to the adjacent tissues in the parietal area. The patient
consulted the local surgeon who tried to remove soft tissue tumour of the parietal area in the clinic.
The tumour was removed in part, the patient was brought take neurosurgical clinic. What mistake
was made by the doctor on inspection and treatment of the patient?
ANSWER. A mistake is insufficient primary examination of the patient craniograme was not
made. Attempt of removal of the tumour intimately adherent to bones of the arch of the skull has led
to that the tumour was not removed radically that could lead to the deterioration of the general
condition of the patient and possibility of bleeding as a complication during and after operation
(early complication) and edema of the brain.

№ 3. The patient of 38 years old vision in the right eye began to reduce. She was treated
under supervision of the oculist, but the sight was progressively reduced at the expense of primary
atrophy of the right optic nerve; the diverticulum of the right eyeball developed 4 months ago and
increased. On inspection the exophthalm on the right, visual acuity of the right eye – 0.05, left – 1.0
are marked. There is a primary atrophy of an optic nerve, stagnation of the disk of the optic nerve on
the left on the eye fundus. Determine the topical diagnosis, apply auxiliary methods of investigation.
ANSWER. The patient has affection of basal part of the right frontal particle with a great
probability of a tumour. It is necessary to use auxiliary methods of investigation –
Echoencephalography, CT-SCAN, a carotid angiography on the right, craniograms .

№ 4. The patient of 52 years old consulted the doctor because of attacks of spasms in the
right extremitys which developed 2 years ago. During the 1-st year there were 3 attacks after which
there was a headache, weakness in the right hand for 30 minutes after the attack. The last 0.5 years
he has attacks with spasms and loss of consciousness which are preceded by numbness and spasms
in the right hand. On examination the patient has insignificant lag in the right hand by the test of
Barra, prevalence of tendon reflexes by hemitype on the right, reduction of pain sensitivity.
Diagnose and determine treatment.
ANSWER. The patient has a tumour of frontal-temporal part on the left. It is recommended:
osteoplastic trepanation, removal of the tumour after inspection. In malignant character application
of chemotherapy and radiation therapy is indicated.

№ 5. The patient is 62 years old. His condition is severe marked headache, vomiting in the
mornings, the limited movements in the left extremities. The patient considers himself ill for 2
weeks,

the condition progressively worsens. The patient has been smoking since from 20-years of age. For
the last year he has constant cough. The patient is under nourished, integuments are pale - grey,
memory is reduced. Make the plan of examination of the patient; determine character of the
pathology, examination and treatment.
ANSWER: The patient has a great probability – cancer of the lungs with metastasises in the
brain. It is necessary to carry out general somatic and oncological inspection of the patient,
roentgenography of organs of the thorax. In detection single metastasis in the right hemisphere of
the brain and in absence of contra-indications on the part of lungs removal of this metastasis with
the subsequent chemotherapy and radiation therapy is indicated after angiography. Symptomatic
treatment. If there are multiple metastasises operative treatment is not indicated. Chemotherapy and
symptomatic treatment are administered.

№ 6. The patient of 42 years old was admitted to the clinic with complaints of headaches
which worsen in the mornings and are accompanied by vomitting, unsteadiness of walking, absence
of hearing in the right ear. When the position of the body is changed he has “a veil” before the eyes.
He has been ill for about 5 years. Noise in the right ear developed first. He was examined and treated
by the OTORHINOLARYNGOLOGISTs, improvement has not been noted, the hearing in the right
ear started to reduce. Two years ago complete deafness developed in the right ear. Headaches at
dawn started to disturb him during the last year. At present headaches are constant. Determine
character of affection of the brain.
ANSWER: The patient with a great probability has neurinoma of the right acoustic nerve.

7. THE LITERATURE RECOMMENDED ON THE THEME OF THE

CLASS: THE MAIN LITERATURE:

1. Handbook of Neurosurgery / Greenberg M.S. – Thieme, 2019. – 1784 p. ISBN 9781684201372

2. Atlas of emergency neurosurgery / [edited by] Jam ie Ullman, P.B. Raksin. - 2015. - 528 p.
Includes bibliographical references and index. ISBN 978-1-60406-368-4 - ISBN 978-1-60406-
369-1.
3. Brain Tumors: An Encyclopedic Approach, Third Edition. Andrew H. Kaye and
Edward R. Laws. © 2012, Elsevier Limited.
4. Greenberg J.O. (ed): Neuroimaging: A companion to Adams and Victor's
Principles of Neurology, New York, McGraw-Hill, 2010.
5. Principles of neurological surgery. 2012. ISBN: 978-1-4377-0701-4.
6. Son A.S., Khomitska T.V., Klaupik L.E., Khrushch A.V. Neurosurgery: Selected lectures:
A manual for students and internist of Higher Medical Educational Establishment of the III-
IV levels of accreditation using English / Ed. by A.S.Son Odessa, OSMU, 2001 – 294 p.
7. Youmans neurological surgery / [edited by] H. Richard Winn.—6th ed. 2011.