paediatric tumours
DESCRIPTION
Paediatric Tumours. Dr Malith Kumarasinghe MBBS (Colombo). Pediatric Neurosurgical Neuropathology. Brain tumors are second only to leukemias in children Brain tumors are the most common solid organ tumor in children 70% of pediatric brain tumors are in the posterior fossa - PowerPoint PPT PresentationTRANSCRIPT
Paediatric TumoursDr Malith Kumarasinghe
MBBS (Colombo)
Pediatric Neurosurgical Neuropathology
Brain tumors are second only to leukemias in children
Brain tumors are the most common solid organ tumor in children
70 of pediatric brain tumors are in the posterior fossandash Pilocytic astrocytomandash Medulloblastomandash Ependymoma
CNS tumors pediatric vs adult Adults 70 of tumors are
supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma
raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)
Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar
astrocytoma)ndash medulloblastoma
Brain tumors intro Intracranial neoplasms
ndash Primaryndash Secondary
raquo Metastaticraquo Local invasion
Tumors of the spinal cord
Primary brain tumors intro Primary brain tumors are rare
ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors
Most common typesndash Astrocytomas
raquo Grades I-IVndash Medulloblastomas
raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Pediatric Neurosurgical Neuropathology
Brain tumors are second only to leukemias in children
Brain tumors are the most common solid organ tumor in children
70 of pediatric brain tumors are in the posterior fossandash Pilocytic astrocytomandash Medulloblastomandash Ependymoma
CNS tumors pediatric vs adult Adults 70 of tumors are
supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma
raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)
Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar
astrocytoma)ndash medulloblastoma
Brain tumors intro Intracranial neoplasms
ndash Primaryndash Secondary
raquo Metastaticraquo Local invasion
Tumors of the spinal cord
Primary brain tumors intro Primary brain tumors are rare
ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors
Most common typesndash Astrocytomas
raquo Grades I-IVndash Medulloblastomas
raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
CNS tumors pediatric vs adult Adults 70 of tumors are
supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma
raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)
Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar
astrocytoma)ndash medulloblastoma
Brain tumors intro Intracranial neoplasms
ndash Primaryndash Secondary
raquo Metastaticraquo Local invasion
Tumors of the spinal cord
Primary brain tumors intro Primary brain tumors are rare
ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors
Most common typesndash Astrocytomas
raquo Grades I-IVndash Medulloblastomas
raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Brain tumors intro Intracranial neoplasms
ndash Primaryndash Secondary
raquo Metastaticraquo Local invasion
Tumors of the spinal cord
Primary brain tumors intro Primary brain tumors are rare
ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors
Most common typesndash Astrocytomas
raquo Grades I-IVndash Medulloblastomas
raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Primary brain tumors intro Primary brain tumors are rare
ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors
Most common typesndash Astrocytomas
raquo Grades I-IVndash Medulloblastomas
raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Clinical presentation Clinical symptoms depend upon
ndash Age location and type of tumor and grade Symptoms may include
ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema
vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)
raquo Pituitary adenoma - pressure on optic chiasm
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI
ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement
raquo typical of high graderaquo also in some low grade ie pilocytic
astrocytomas
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
CNS tumors location Extra-axial
ndash meningiomas Cerebral hemispheres
ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma
(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma
GBM
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
CNS tumors location posterior fossa (in children)
ndash pilocytic astrocytomandash medulloblastoma
brainstem (pons) ndash pontine glioma (astrocytoma)
spinal cordndash low-grade astrocytomas (grade I and II)
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve
raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance
raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Pilocytic astrocytomas
Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Astrocytoma - high grade Astrocytoma grade II and III are very very rare
in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral
hemispheres Contrast enhancing tumor Histological appearance
ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Glioblastoma (grade IV)
Less common in children than adults typical pathology (necrosis with psuedopallisading)
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Pontine glioma
Diffuse expansion of pons usually high grade astrocytoma (III-IV)
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Medulloblastomas posterior fossa in children Histologic appearance
ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation
raquo Homer Wright rosettesraquo GFAP positive cells
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Medulloblastoma
Mass arising in roof of fourth ventricle
Homer Wright rosettes
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Ependymoma
Mass arising in floor of fourth ventricle
Perivascular pseudorosettes
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Meningiomas Discrete non-invasive tumor
ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull
common Histologic appearance
ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies
Rare in children may be intraventricular (lateral ventricles)
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Meningiomas
Extra-axial tumor meningothelial cells whorls and psammoma bodies
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Ganglioglioma
Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased
glial cells (usually astrocytic)
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Craniopharyngioma
Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin
often calcified
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Choroid plexus papilloma
Lateral ventricle in children (fourth ventricle in adults)
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Germ cell tumors
Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor
50 female Tertomas are rare
Germinoma Teratoma
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Metastatic tumors The most common ldquobrainrdquo tumor in adults
is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children
is osteosarcoma Local extension of malignant tumors of
vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Other tumors Subependymal giant cell astrocytoma (SEGA)
ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)
ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)
ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)
ndash Infants posterior fossa very malignant Eosinophilic granuloma
ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull
Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated
with seizures
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Hereditary syndromes Neurofibromatosis type I
ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath
tumor Neurofibromatosis type II
ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
1048708 Most intraspinal tumors present by compression rather than invasion
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Compression Syndromes
1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)
1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Compression Syndromes
1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)
1048708 Posteriorndash rare produces paresthesias impairedposterior column function
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Compression Syndromes
1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2
segments belowinjuryndash ipsilateral loss of posterior column function and
weaknessndash best prognosis of any spinal cord syndrome
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Compression Syndromes1048708 Central
ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Location
1048708 Extradural (ED)1048708 Intradural
Extramedullary(IDEM)
1048708 Intramedullary (IM)
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Extradural Tumors1048708 55 of spine tumors
1048708 tissues bone epidural fat vessels
1048708 majority are metastatic
1048708 ldquofeatheredrdquoappearance on myelogram
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Extradural Tumors Metastatic
ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)
Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Spine Based Tumors
1048708 Benignndash hemangioma osteoid osteomaosteoblastoma
osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts
1048708 Malignantndash chordoma osteosarcoma chondrosarcoma
fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas
Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets
Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
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- Slide 31
- Slide 32
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- Slide 34
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- Slide 36
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- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
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Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30
ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Treatment
Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life
Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Radiation Therapy
Most patients with primary spinal cord tumors will not require radiation therapy
Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations
Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Chemotherapy
Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-
Thank you
- Paediatric Tumours
- Pediatric Neurosurgical Neuropathology
- CNS tumors pediatric vs adult
- Brain tumors intro
- Primary brain tumors intro
- Clinical presentation
- CNS tumors diagnosis
- CNS tumors location
- CNS tumors location (2)
- Pilocytic astrocytomas
- Pilocytic astrocytomas (2)
- Astrocytoma - high grade
- Glioblastoma (grade IV)
- Pontine glioma
- Medulloblastomas
- Medulloblastoma
- Ependymoma
- Meningiomas
- Meningiomas (2)
- Ganglioglioma
- Craniopharyngioma
- Choroid plexus papilloma
- Germ cell tumors
- Metastatic tumors
- Other tumors
- Hereditary syndromes
- Slide 27
- Slide 28
- Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Treatment
- Slide 47
- Slide 48
- Slide 49
- Slide 50
-