Flashcards in Intracranial tumours surgical aspects Deck (21)
how do people with intracranial tumours present
raised intracranial pressure
endocrine dysfunction- affect hypothalamus and pituitary
incidental- often benign.
how does intracranial pressure cause haemorrhages
when you sleep carbon dioxide builds up.
when you are sleeping the head has increased pressure.
how does intracranial pressure cause vomitting and nausea
due to meningitis
how does intracranial pressure cause visual field defects
often due to papilodema
what are the main causes of raised intracranial pressure
tumour mass growth
obstructive hydrocephalus- blocks ventricular system at narrowing. e.g. median and lateral apertures.
what are the 3 main types of seizures
what are the main categories of neurological deficit
cranial nerves- 3,4,6
motor and sensory
how can a tumour affect hormone levels
if tumour presses on hypothalamus or pituitary gland it can result in reduced levels of certain hormones.
what investigations are undertaken for someone who presents with high intracranial pressure.
Haematological- some tumours increase erthrypotein and therefore Hb, found in kidney, liver etc.
Tumor markers- aFP,Bhcg,PSA – tells you where tumour.
Hormonal assay- different levels of hormone depending on where the tumour is.
Visual fields- nasal or temporal visual loss due to tumour at optic chiasm., causes bitemopral hemianopia.
Chest X ray – primary tumour or metastasis.
what are the main forms of imagine used in raised intracranial pressure
Computerised tomographic scan-1st thing you do.
Magnetic resonance imaging- shows better soft tissue than CT
Cerebral angiography- show blood vessels, so you know the risk which will be present if surgery needs to take place so you can embolize the blood vessels.
what is the function of fMRI
imaging of the brain when asking the patient to talk/ draw etc to see which parts of the brain are involved in the function they are being asked to do.
what is the function of DTI
Allows you to follow where the white matter is of the corticospinal tracts.
How is raised intracranial pressure managed
Medical- Steroids- reduces inflammation, lots of side effects if used for too long, anti-convulsants- seizures, hormonal replacement
how is a sterotactic biopsy carried out for biopsy of a tumour
– Frame put on
– each area of the scan has a co-ordinate
– So you can use the co-ordinate to direct the needle exactly into the tumour.
how is neuronavigation carried out for biopsy of a tumour
– Put in scan data plot the probes which leads you to tumour.
how is the type of tumours diagnosed
what chemicals given before tumour removal surgery that highlights the tumour in a different colour so it can easily be resected
what are giladel wafers
chemotherapy wafers put in the brain after surgery because chemotherapy cannot enter cross the BBB.
what is intraopertive MRI
MRI within theatre to see if tumour is still left if it is then go back into surgery to remove it.
what are the common examples of adjuvant therapy for tumours
radiotherapy and chemotherapy.