tumorastrositoma bedahsaraf

8/19/2019 Tumorastrositoma bedahsaraf

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TUMOR ASTROSITOMAREFERAT SARAF

Dewi Septina Sari Hasyim


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DEFINISI

Astrositoma merupakan neuplasma yang berasl

dari sel-sel astrosit dan merupakan tipe tumaor

yang paling banyak ditemukan pada anak-anak


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SEL GLIA

Fungsi : penopang struktural dan nutrisional bagi

neuron, isolasi elektrikal, menaikkan konduksi impuls

disepanjang akson.

Ada dua jenis sel glia :Sel glia pada sistem saraf pusat

Sel glia pada sistem saraf tepi


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SEL GLIA PADA SSP

Astroglia ( astrosit)

OligodendrositSel ependima

Sel mikroglia


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SEL GLIA PADA SISTEM SARAF TEPI

Sel schawan

Sel satelit


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KALSIFIKASI TUMOR ASTROSITOMA


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ETIOLOGI

Penyebab pasti astrostoma tidak diketahui

(ideopatik)

Anak dengan leukemia limfositik akut (ALL)

yang menerima radioterapi profilaksis pada

susunan saraf pusat akan meningkatkan resiko

tumor astrositoma

Makanan yang bnayak mengandung senyawa

nitroso ( nitosurea, nitrosamine)

Pemaparan sinar x


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PATOFISIOLOGI

Adanya efek regional astrositoma berupa

kompresi, invasi, dan destruksi dari perenkim

otak gangguan elektrolit, gangguan

neurotransmitter serta pelepasan

mediator0mediator seluler seperti sitokin yangakan fungsi parenkin normal.

Peningkatan TIK efek lansung dari massa yg

akan meningkatkan volume darah atau

meningkatkan cairan cerebrospinal gejalaklinis.

Tanda dan gejala klinis gangguan fungsi saraf

pusat.


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DIAGNOSIS

AnamnesisGejalan neurologis dari astrositoma tergantung

tempat dan luas permukaan tumorpada SSP

Gangguan status menta, kangguan kognitif, cepalghi,

gangguan visual (diplobia), gangguan motorik,kejang.

Gejala peningkatan TIK : sakit kepala, muntah dan

letarghi

Kelemahan satu sisi tubuh, hilangnya keseimbangan


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Pemeriksaan fisik Adanya tanda-tanda sakit kepala, mual, muntah,

gangguan kognitif, papil edema, tanda lokalisasi dan

lateralisasikelumpuhan n.cranialis, hemiparese,

gangguan sensorik, gangguan reflek fisologis, refelekpatologis positif.

Invasi pada area motorik, traktus hemiparesi

diikuti hemiplegi

Invasi pada area bahasa afasia

Korteks serebral kejang

Lobus frontal otak perubahan secara bertahap

terhadap kepribadian


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PEMERIKSAAN PENUNJANG

Ct-scan


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PENATALAKSANAAN

Pembedahan

Radioterapi

Kemoterapi

KorticosteroidExternal ventrikular drain

Antikonvulsan


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CLINICAL PRESENTATION Clinical symptoms depend upon: Age, location, and type of tumor and grade

Symptoms may include:Increased intracranial pressure

secondary to obstruction of CSF at aqueducthydrocephalus (infants), headache, papilledema, vomiting

seizures

focal neurological deficits

hormonal changes (pituitary adenoma)

visual changes (diplopia, field defects)Pituitary adenoma - pressure on optic chiasm


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CNS TUMORS: DIAGNOSIS

Symptoms prompt neuroimaging

CT and MRIintra-axial vs. extra-axial

Location of tumor

contrast enhancementtypical of high grade

also in some low grade, i.e., pilocytic astrocytomas


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CNS TUMORS: LOCATION

Extra-axial meningiomas

Cerebral hemispheresgrade II-III astrocytomas, GBM

Crossing corpus callosum -GBM

optic nerve -pilocytic astrocytoma (NF-1)

Sella -Pituitary adenoma

Peri-III ventricle -Pilocytic astrocytoma, GBM


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CNS TUMORS: LOCATION

posterior fossa (in children)pilocytic astrocytoma

medulloblastoma

brainstem (pons) pontine glioma (astrocytoma)

spinal cord

low-grade astrocytomas (grade I and II)


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PILOCYTIC ASTROCYTOMASMost common in children

Grade I astrocytoma

Cerebellum (posterior fossa), optic nerveThalamic, spinal cord, cerebral

Discrete, well circumscribed massOften with associated cystic area

Contrast enhancing

Histologic appearance:Biphasic: piloid cells and microcystic areasRosenthal fibers

no mitoses


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PILOCYTIC ASTROCYTOMAS

Tumor of cerebellum, often with cyst,

biphasic, Rosenthal fibers, piloid

cells


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ASTROCYTOMA - HIGH

GRADE

Astrocytoma grade II and III are very, very rare inthe pediatric population

Grade IV - glioblastoma multiforme

Diffusely infiltrating glial tumor of cerebral

hemispheresContrast enhancing tumor

Histological appearance:Densely cellular, with marked nuclear pleomorphism

Numerous mitosesEndothelial proliferation

Necrosis with pseudopallisading


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GLIOBLASTOMA (GRADE

IV)

Less common in children than adults, typical

pathology (necrosis with psuedopallisading)


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PONTINE GLIOMA

Diffuse expansion of pons, usually high gradeastrocytoma (III-IV)


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MEDULLOBLASTOMAS

PNET of posterior fossa in childrenHistologic appearance:Densely cellular “small blue cell tumor”

Numerous mitoses

Apoptotic (karyorrhectic) cells

Endothelial proliferation

Necrosis

neuronal or glial differentiationHomer Wright rosettes

GFAP positive cells


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MEDULLOBLASTOMA

Mass arising in roof of

fourth ventricle

Homer Wright rosettes


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EPENDYMOMA

Mass arising in floor of

fourth ventricle

Perivascularpseudorosettes


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MENINGIOMAS

Discrete non-invasive tumorExtra-axial, pushes into brain

Attached to dura

Hyperostosis or invasion of skull common

Histologic appearance:Fibroblastic or menigothelial cells

Meningothelial whorls

Psammoma bodiesRare in children, may be intraventricular

(lateral ventricles)


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MENINGIOMAS

Extra-axial tumor, meningothelial cells, whorls and

psammoma bodies


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GANGLIOGLIOMA

Cerebrum, cervicomedullary, often with cystic component

Increased numbers of neurons (some binucleate) and increased glial cells(usually astrocytic)


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CRANIOPHARYNGIOMA

Heterogeneous, cystic mass in suprasellar regionBasiloid layer, stellate reticulum, “wet” keratin, often

calcified


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CHOROID PLEXUS PAPILLOMA

Lateral ventricle in children (fourth

ventricle in adults)


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GERM CELL TUMORS

Pineal - 99% males, most are germinomas

Suprasellar - often mixed germ cell tumor, 50%

female

Tertomas are rare

Germinoma Teratoma


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METASTATIC TUMORS

The most common “brain” tumor in adults ismetastatic

Metastatic tumors are rare in children

The most common metastatic tumor in children is

osteosarcomaLocal extension of malignant tumors of vertebral

bodies (Ewing’s sarcoma) or paravertebral soft

tissues (neuroblastoma) are not uncommon

tumorastrositoma bedahsaraf

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