Zelin Sun MD, Ph.

D
孙泽林 博士

DEPARTMENT OF NEUROSURGERY
AFFILIATED HOSPITAL
NORTH CHINA UNIVERSITY OF SCIENCE AND
TECHNOLOGY
BRAIN TUMOR
overview

Etiopathogenisis
 Not clearly
 Hypothesis of oncogene
 Inducement :
trauma;
exposure under radiation;
chemical materials;
virus or other biological
factor
overview
Categorization
 Classificationaccording to
original location :
Protopathic tumor ;
Secondum tumor
 Secondum tumor :

Metastatic tumor;
Tumor intrude into cra
nial cavity
 Overview
Categorization （ continue

）
Astrocytic glioma or Ependymocytoma
origined from neural epithelium.
 Meningeoma or Meningeal sarcoma
meninges;
 Acoustic neurinoma or Trigeminal neurinoma
cranial nerve;
 Pituitary adenoma
pituitary gland;
 Aneurysm or Angioreticuloma
blood vessel;
 Craniopharyngioma or Dysembryoma
remainder embryo tissue.
 Not elsewhere classified
overview
Epidemiology
 Incidence rate:
Protopathic tumor: 7.
8-12.5/one hundred thousand
Secondum tumor : 2.1-1
1.1/one hundred thousand
overview Epidemiology Age:
Child: posterior cranial fossa, linea
mediana
exp: medulloblastoma, craniopha
ryngeal duct tumor
 Adult: may local at anywhere of the
brain
exp: Astrocytic glioma , Mening
eoma Acoustic neurinoma , Pituitary adeno
ma or Aneurysm
overview
Clinical Findings
The intracranial hypertension triad syndrome
 Headache
Chronic headache. If the headache is acute
， the tumor of the patient maybe malignant.
 Vomit
ejection not just effluent
 Papilledema
May accompaniment with atrophia nervi opt
ici
overview
Clinical Findings (cont
inues)
Consciousness
 Conscious.
 Lethargic, Drowsy or Tupor
 Superficial coma
 Middle coma
 Deep coma
GCS score ： 3 — deep coma ；
≥ 7 — coma
sensory examination Motor examination
overview
Clinical Findings
(continues)
Focal signs and symptoms
 Hemiplegia —— anterior central gy
rus
 Hypoesthesia or Numbness —— poster
ior central gyrus
 Hemianopsia —— chiasm opticum
 Hearing loss or Deafness —— acousti
c nerve
 Aphasia —— Borca’s area, temporal l
obe, left
overview Clinical Findings (contin
ues)
Focal sings and symptoms
 Epilepsy —— cerebral cortex , temporal o
r parietal lobe
 Facial paralysis—— seventh nerve
 Trigeminal neuralgia —— fifth cra
nial nerve
 Diabetes or Insipidus —— Hypothal
amus , Pituitary
 Amenorrhea （ abnormal menstruation ） and Galact
orrhea , Gigantism(N excessive growth of the entire
body, caused by overproduction of growth hormone by the pituitary
gland during childhood or adolescence)  , Moon face a
overview
Diagnose
 History
 Physical examination
 Auxiliary examination :
CT (Computed tomography);
MRI (Magnetic Resonance Imaging);
DSA( Digital Subtraction Angiography);
EEG (Electroencephalogram)
overview
Treatment
 General treatment: dehydration-
mannitol or glycerine levoglucose ；
keep vital sign stable
 Operation : craniotomy
 Radiotherapy, Chemotherapy or Gamma
ray knife
overview
Prognosis
 Benign tumor: resectted
totally ， recovered entirely
 Malignant tumor : tumor recurrence
sooner or later ， the patient may die for
cerebral hernia or other complications
for example: lung infection ， heart
failure and so on.
Case 1
Clinical Findings
 Man 62 years old

 Chief complaint: Dizziness, headache

and gait instablility during 1
month ， aggravate for 15 days
Case 1 2010-03-30 （ before operations ） CT
Case 1
2010-03-30 （ before operations ）
MRI
horizontal position
Case 1
2010-03-30 （ before operations ）
MRI
anteroposterior axes
Case 1
 Diagnose ：
Swelling in vermiform process of
cerebellum. Pathologic diagnosis
maybe glioma.
 Treatment :

Craniotomy to remove the tumor.

Radiotherapy, Chemotherapy or
Gamma ray knife after operation
Case 1
During the operation
The position of the body and the head
Case 1
During the operation
The picture of the Craniotomy
Case 1
Pathology: Malignant
glioblastome
Case 1

Condition of the man before discharged

from our ward is very good. He can walk by
himself totally. The dizziness and headache
of the patient had been dispeared.

Prognosis: This man may also die in two

years for the tumor being the most
malignant tumor.
Case 2
Clinical Findings
 Female 58 years old

 Chief complaint: Outburst once time

epilepsy 4 hours before visit in our
hospital.
Case 2
2010-04-2 （ before operations ） CT
Case 2
2010-4-3 （ before operations ）
MRI
Case 2
2010-4-3 （ before operations ）
MRI
Case 2
2010-04-3 （ before operations ）
MRI
anteroposterior axes
Case 2
 Diagnose ：
Swelling in right side frontal lobe.
Pathologic diagnosis maybe
meningeoma.
 Treatment :

Craniotomy to remove the tumor.

Radiotherapy, Chemotherapy or
Gamma ray knife after operation
Case 2
During the operation
The position of the body and the head
Case 2
The comparison of MRI before and
after the operation
Case 2
Pathology: Meninggeoma
Case 2

Condition of the woman

before discharged from
our ward is very good. The
epilepsy of the patient had
not happened again.

Prognosis: The disease

woman may have been
cured entirely for the
tumor is a benign tumor
tumor.
Case 3
Clinical Findings
 Female 46 years old

 Chief complaint: Hearing loss during 2

years.
Case 3
2010-05-12 （ before operations ） CT
Inner auditory meatus enlarged
Case 3
MRI （ before operations ）
Case 3

 Diagnose ：
Swelling in right side
CPA （ cerebellopontine angle ）
area. Pathologic diagnosis maybe
schwannoma of acoustic nerve.
 Treatment :

Craniotomy to remove the tumor.

Case 3
During the operation
The position of the body and the head
Case 3
Pathology: Acoustic neutinoma
MRI （ after operations ）
Case 3
Condition of the woman
before discharged from
our ward is good. She has
a little facial palsy on her
right side which may
recovered in 3 or 6 month
after the operation.

Prognosis: The disease

woman may have been
cured for the tumor is
benign.
Case 4
Clinical Findings
Man 37 years old

Chief complaint: Numbness on

the right face for 2 years,
dizziness and headache for 10
days
Case 4
MRI （ before operations ）
Case 4
MRI before operations （ diffusion
weighted imaging ,DWI ）
Case 4

 Diagnose ：
Swelling in middle and posterior
cranial fossa.
Pathologic diagnosis maybe
cholesteatoma.
 Treatment :

Craniotomy to remove the tumor.

Case 4
During the operation
The position of the body and the head
Case 4
Pathology: Cholesteatoma
MRI （ after operations ）
Case 4

Condition of the man before discharged

from our ward is good. He has nothing
complaint and symptom.

Prognosis: The man may have been

cured for the tumor is benign.
Case 4

再加上脊柱肿瘤
腔镜垂体瘤切除术。