TUMOR OTAK

BRAIN AND SPINE TUMOR 1

 PENDAHULUAN
 Insiden
 Primer: 6/100.000 pertahun
 Sekunder: metastasis lebih sedikit

 Lokasi Tumor
 Supratentorial : dewasa 80% > anak 20%
 Infratentorial : dewasa 40% < anak 60%

BRAIN AND SPINE TUMOR 2

 PATOLOGI
 BENIGNA (jinak)
 Batas tegas, tumbuh lambat, soliter
 Cth: Meningioma, schwannoma

 MALIGNA (ganas)
 Batas tidak tegas, tumbuh cepat, infiltratif,
diferensiasi jelek, nekrosis, mitosis >>
 Cth: glioblastoma

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 KLASIFIKASI PATOLOGI (1)
 Neuroepitelial
 Astrositoma
 Oligodendroglioma
 Ependimoma
 Pinealoma
 Glioblastoma multiforme (GBM)

 Meningen :
 Meningioma

 Sel sarung saraf:

 Schwannoma/acoustic neurinoma
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 KLASIFIKASI PATOLOGI (2)
 Pembuluh darah
 Hemangioma

 Germ sel
 Germinoma
 Teratoma

 Tumor dari mal development

 Craniopharyngioma
 Kista
aug '06 epidermoid
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 KLASIFIKASI PATOLOGI (3)
 Glandula pituitary (hipofisa)
 Adenoma pituitary
 Adenocarcinoma

 Tumor sekitar (tulang)

 Chordoma
 Glomus jugulare
 Chondroma/chondrosarkoma

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 KLASIFIKASI LAIN
 TUMOR PRIMER
 OTAK :
 Intra axial : glioma, pinealoma, meduloblastoma
 Extra axial : meningioma, schwannoma, chordoma

 MEDULA SPINALIS
 Intramedulare : ependimoma, astrositoma
 Extramedulare : meningioma, schwannoma

 TUMOR SEKUNDER (metastasis)

aug '06  Mammae, tiroid, paru, prostat
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 GEJALA
 Nyeri kepala kronik progresif
 lokasi jelas
 Memberat pagi hari
 Terbangun malam hari
 Akibat tekanan sinus, dura, arteri, N.V

 Mual atau muntah (proyektil)

 Rangsang CTZ di ventrikel ke-4

 Kejang
 Fokal (astositoma, oligodendroglioma)
aug '06
 General (deepBRAIN
gray matter, intraventrikular)
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 GEJALA & TANDA

 Progresif hemiparesis
 Paresis N.cranial
 N. VI (false localizing sign)

 Funduskopi : Papil edema

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 TRIAS TIK

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 Parese N.VI

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 TANDA
 PRIMER
 Sindrom Foster Kennedy
 Sindrom Gertsmann
 Sindrom lobus temporalis
 Sindrom Anton
 Sindrom Parinaud

 SEKUNDER (komplikasi)
 Hidrosefalus
 Edema peritumor
 Midline shift (herniasi)
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 Sindrom Foster Kennedy

Lobus frontalis: meningioma, glioma

 Anosmia :kompresi lgs

 Papil atrofi ipsilateral :kompresi lgs
 Papil edema kontralateral :TIK

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 Sindrom Gertsmann
Gyrus angularis (lobus parietal)

 Finger agnosia
 Left-right disorientation
 Agraphia
 Acalculia

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 Sindrom Lobus Temporalis
 Uncinate fits
 Complex partial seizure (CPS)
 Otomatisasi
 Halusinasi (visual, olfactorius, auditory, gustatory)
 Piloereksi

 Kluver-Bucy sindrom (bilateral lobus temporal)

 Visual agnosia
 Hilang rasa takut & marah
 Hipersex
 Bulimia
 Hilang memori
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 Sindrom Anton

Lesi oksipital bilateral

 Cortical blindness
 Hemianopsi homonim
 “saya tidak buta”

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 Sindrom Parinaud
 Kelainan : Pinealoma
 Kompresi mesencephalon dorsalis
 Kompresi tectum
 obstruksi V.III

 Gangguan konvergensi
 Gangguan upgaze
 Gangguan “light-near dissociation”
 Lid retraction (Coelier Sign)
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 HIDROSEFALUS
 Hidrosefalus obstruksi (kompresi)

 Nyeri kepala ≈ migren klasik

 Gait ataksia

 Ventrikel III anterior

 Hemianopsi bitemporal
 Gg.hipotalamus

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 HERNIASI
 SUPRATENTORIAL
 UNCAL :Pupil anisokor, hemiparesis
 CENTRAL :gait weakness, pupil isokor

 INFRATENTORIAL
 Kaku kuduk, muntah, respirasi iregular
 Cepat meninggal

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 PENUNJANG
 X-FOTO
 Thorax
 Cranial

 CT-scan
 MRI
 Angiografi
 Lab : tumor marker

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 DIAGNOSIS BANDING
 Vaskular
 Hematom (ICH, SAH)
 Aneurisma
 AVM
 Trombosis venous
 Trauma
 Hematom (EDH, SDH, ICH)
 Infeksi
 Abses
 Tuberkuloma
 Kista
 Kista arachnoid
 Hidatid (parasit)
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 TERAPI
 STEROID (edema vaskular)
 Dexametason bolus 2 ampul (10mg)
 Maintenance 4x1 ampul (5mg)

 Operatif
 Radioterapi
 Kemoterapi

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 TUMOR
MEDULA SPINALIS

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 ANATOMI
Mielum: for.magnum - conus medularis
Segmen
 Cervical : C1-8
 Thoracal : T1-12
 Lumbal : L1-5
 Sakral : S1-5
 Coxygeus : cox1-4 --------total 34

Epiconus : L4-L5-S1-S2 (empedu)

Conus medularis : S3-4-5-C (koteka)
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 ASCENDENS MEDULARE
Myelum lebih pendek daripada vertebra

vertebra Segmen mielum

Cervikal +1

Thoracal +2

Lumbal +3

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 TRAKTUS MEDULA SPINALIS

1. Traktus corticospinalis (piramidalis)

2. Traktus spinotalamikus
1. Lateral (nyeri , suhu)
2. Anterior (raba halus)
3. Funikulus posterior (posisi, getaran)

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 DIAGNOSIS
KLINIK
 Paraparesis UMN : T2-L2
 Tetraparesis UMN : C2-T1

Batas lesi
 Sensibilitas:
Dermatom
propioseptik
 Motorik : miotom
 Otonom:
perspirasi tes : iodium + amilum = biru
kandung kemih : retensio (S2-4), inkontinensia (atas S2)
 Reflek fisiologik
 Vertebra

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 PENUNJANG
X-FOTO vertebra AP/Lateral
CT-scan tulang
MRI spinal
Mielografi
LP :
 Sindrom FROIN
 Queckensted
 Ayala Index
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 MODEL SENSORIK DEFISIT..

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 LP untuk Blok spinal
Sindrom Froin
 Sel normal (N=0-5)
 Protein ↑ (N=4-50mg%)

Queckenstedt tes
 N= Tekan v.jugularis bilateral --- aliran ↑
 Blok = tekanan tetap (N=180 mmH20)

Ayala Index
 AI= (tekanan setelah ambil 10cc X 10 ) / tek.awal
 N = 5,5-6,5
 Blok < 5,5
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 TUMOR MIELUM
ASAL
 Primer
 Sekunder : metastasis

Letak
 Extra dural (10%)
 Intra dural extramedulare (65%)
 Intra dural intramedulare (14%)

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 Perbedaan Intra vs extra medulare
Extramedulare Intramedulare
Nyeri spontan Radikular Terbakar
Jelas lokasi Tidak jelas
Defisit sensorik Nyeri &suhu (KL) Disosiasi sensibilitas
Propioseptik (ipsi)
Sensasi nyeri-suhu di Terganggu Kurang terganggu
Saddle area
LMN segmental Jelas,
Atrofi,fasikulasi
UMN Early Late
Reflek fisiologik Early Late
Reflek patologik Early Late
Perubahan kulit Jarang Sering
Blok
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BRAIN AND SPINE TUMOR Late 40
 GIBUS

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 TERIMA KASIH

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