glioblastoma
Introduction
Introduction to glioblastoma Gyomas, also known as gliomas, are gliomas, which are tumors that occur in the neuroectodermal layer. They are also called neuroectodermal tumors or neuroepithelial tumors. The tumors originate from the nerve stromal cells, ie, the nerves. Glial, ependymal, choroid plexus epithelium and neuronal cells, ie neurons. Most tumors originate from different types of glia, but according to histological sources and biological characteristics, various tumors occurring in the neuroectoderm are generally called gliomas. basic knowledge The proportion of illness: 0.001% - 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: hemiplegia aphasia
Cause
Glioblastoma etiology
As the tumor gradually enlarges, it forms an intracranial space-occupying lesion, often accompanied by peripheral cerebral edema. When the compensation limit is exceeded, the intracranial pressure is increased. When the tumor blocks the cerebrospinal fluid circulation or compresses the vein, the venous return disorder occurs. Increased intracranial pressure, such as hemorrhage, necrosis and cyst formation in the tumor, can speed up the process, when the intracranial pressure increases to the critical point, the intracranial volume continues to increase a small amount, the intracranial pressure will increase rapidly, such as Intracranial pressure monitoring, when the pressure reaches 6.67 ~ 13.3 kPa Hg, the plateau wave appears, the plateau wave appears repeatedly, and the duration is long, which is the clinical sign. When the intracranial pressure is equal to the arterial pressure, the cerebral vasculature is paralyzed. The cerebral blood flow stops, the blood pressure drops, and the patient will die soon.
The tumor is enlarged, the local intracranial pressure is the highest, and the pressure gradient is generated between the intracranial cavities, causing the brain to shift, and gradually increasing the cerebral palsy. The supratentorial cerebral hemisphere tumor can produce the cerebral palsy, and the cingulates move back through the midline. It can cause wedge-shaped necrosis, and the periorbital artery can also be displaced by pressure. Severe cerebral infarction in the supply area can occur. More importantly, the cerebellar incision is parasitic, that is, the medial temporal sulcus back through the cerebellar cerebral incision to the posterior fossa Displacement, the ipsilateral oculomotor nerve is paralyzed, the pupil is dilated, the photoreaction disappears, the midbrain's cerebral ankle is compressed to produce contralateral hemiplegia, and sometimes the contralateral cerebral pedicle is pressed against the cerebellar margin or the tip of the bone, producing the same Lateral hemiplegia, posterior choroidal artery and posterior cerebral artery may also be subjected to ischemic necrosis. Finally, compression of the brainstem may produce a downward axial shift, resulting in infarction in the midbrain and pons, coma, blood pressure, pulse Slow, breathing deep and irregular, and can go to the brain tough, and finally stop breathing, blood pressure drops, cardiac arrest and death, the posterior cranial fossa tumor can produce large occipital foramen magnum, cerebellar tonsil downward shift out of the pillow Severe delayed medullary compression on the anterior border of the occipital foramen, on-screen tumor can also be associated with occipital foramen magnum, resulting in medullary ischemia, patient coma, blood pressure rises, the pulse is slow and powerful, breathing deep without planning, and then breathing Stop, blood pressure drops, pulse speed is weak, and eventually death.
Prevention
Glioblastoma prevention
There are no effective preventive measures for this disease.
The latest research by Dr. Finocchiaro of Neuroscience in Milan, Italy, confirmed that neural stem cells of the central nervous system are an effective means of treating brain glioma.
Glioma is a short-lived malignant tumor of the brain. It has a poor effect on chemotherapy and radiotherapy. Therefore, people hope that gene therapy will stimulate the immune system against tumors with genetically modified viruses. But so far, gene therapy Unable to provide long-term efficacy, unable to reach all tumor cells.
To solve this problem, the researchers used neural stem cells to replace the virus, and injected the immune stimulating factor IL-4 modified stem cells into mice with brain tumors. The brain tumors are similar to human gliomas, and unmodified. In the stem cell group and the control group, after 90 days of injection, 6 of the 7 mice in the stem cell modification group survived, and all the control groups died. The survival time of the unmodified stem cell group was also longer than that of the control group, indicating that the stem cells themselves have resistance. The role of brain tumors, while stem cells carrying IL-4 have a stronger anti-tumor effect, more effective than genetically modified viruses, because stem cells are not rejected by the body, can be like the tumor cells throughout the central nervous system.
The current problem is that the technology for large-scale cultivation of stem cells needs to be improved. In addition, it is necessary to determine which types of stem cells and immunopotentiators are more effective for treatment.
Complication
Glioblastoma complications Complications hemiplegia aphasia
Hemiplegia, aphasia and other symptoms can occur.
Symptom
Glioma symptoms Common symptoms Nausea increased intracranial pressure Diplopia cerebral gray matter abnormal papilledema
Symptoms mainly have two aspects, one is increased intracranial pressure and other general symptoms, such as headache, vomiting, vision loss, diplopia, seizures and mental symptoms, and the other is the compression, infiltration and destruction of brain tissue by the tumor. The resulting local symptoms cause loss of nerve function.
Most of the headaches are caused by increased intracranial pressure. The intracranial pressure of tumor growth is gradually increased, and the pressure is involved in the intracranial pain-sensitive structures such as blood vessels, dura mater and some cranial nerves. Most of them are headache, pain, and more parts. In the frontal or occipital part, one side of the cerebral hemisphere is shallow, the headache can be mainly on the affected side, the headache starts intermittently, and occurs mostly in the early morning. As the tumor develops, the headache gradually worsens and the duration is prolonged.
Vomiting is caused by stimulation of the medullary vomiting center or vagus nerve. It can be nausea-free, it is jetting. In children, headache can not be separated due to cranial suture, and because the posterior fossa tumor is more common, vomiting is more prominent.
Increased intracranial pressure can produce papilledema, and long-term optic nerve secondary atrophy, decreased visual acuity, tumor oppression of the optic nerve to produce primary optic atrophy, resulting in decreased vision, abductor nerves are susceptible to crushing, often causing paralysis, Produce double vision.
Some cancer patients have epilepsy symptoms, and can be early symptoms. Epilepsy begins in adulthood. The latter is usually symptomatic. Most of them are caused by brain tumors. If the drug is difficult to control or the nature of the seizure changes, all brain tumors should be considered. Epilepsy is prone to occur in the adjacent cortex, and rare in the deeper, localized epilepsy has a localized significance.
Some tumors, especially those located in the frontal lobe, may gradually develop mental symptoms such as personality changes, apathy, reduced speech and activity, lack of concentration, memory loss, lack of concern for things, and ignorance.
Local symptoms are caused by the corresponding symptoms in the tumor, and progressively worse, especially malignant glioma, which grows faster, destroys the brain tissue, and the surrounding brain edema is also obvious. The local symptoms are obvious and the development is also fast. Internal tumors or tumors located in the resting area may have no local symptoms in the early stage, but local symptoms may occur in the early stage of tumors such as the brainstem and other important functional parts. After a long period of time, symptoms of increased intracranial pressure appear, and some tumors that develop slower, Due to the compensatory effect, symptoms of increased intracranial pressure often occur in the late stage.
Examine
Glioblastoma examination
(1) Cerebrospinal fluid examination: Most of the lumbar puncture pressure is increased. Some tumors such as the brain surface or the cerebral ventricle can increase the amount of protein in the cerebrospinal fluid, and the number of white blood cells can also increase. Some can find tumor cells, but the intracranial pressure is significantly increased. Lumbar puncture has the risk of promoting cerebral palsy, so it is generally only necessary when necessary. If it needs to be differentiated from inflammation or hemorrhage, the pressure should be increased. The operation should be cautious. Do not put more cerebrospinal fluid, and give mannitol drops after surgery. Note, pay attention to observation.
(2) Ultrasound examination: it can help to fix the side and observe the presence or absence of hydrocephalus. For infants, B-mode ultrasound scan can be performed through the anterior iliac crest, which can show tumor images and other pathological changes.
(3) EEG examination: EEG changes in gliomas are limited to changes in brain waves at the tumor site, and on the other hand are generally widely distributed frequencies and amplitude changes, which are affected by tumor size and infiltration. Sexuality, the degree of cerebral edema and increased intracranial pressure, shallow tumors are prone to localized abnormalities, while deep tumors are less limited, in benign astrocytoma, oligodendroglioma and other major manifestations For localized delta waves, some may have epileptic waves such as spikes or sharp waves. Large polymorphic glioblastomas can exhibit a wide range of delta waves, sometimes only on the side.
(4) Radioisotope scanning (Y-ray brain map): tumors with abundant growth and fast blood supply, high blood-brain barrier permeability, high isotope absorption rate, such as polymorphic glioblastoma showing isotope-concentrated images In the middle, there may be a low-density area due to necrosis and cyst formation. It needs to be differentiated from metastatic tumors according to its shape, multiple, etc. The amphoteric tumors and other benign gliomas have lower concentrations, often slightly higher than the surrounding. Brain tissue, the image is not clear, and some can be negative.
(5) Radiological examination: including cranial plain film, ventriculography, computed tomography, etc., cranial plain film can show increased intracranial pressure, tumor calcification and pineal calcification shift, ventricular angiography can show cerebral vascular migration Location and tumor vascular conditions, these abnormal changes, different types of tumors in different parts of the different types, can help to locate, and sometimes even qualitative, especially the CT scan has the greatest diagnostic value, intravenous contrast agent enhanced scan, positioning accuracy Almost 100%, the qualitative diagnosis accuracy rate can reach more than 90%, it can show the location, extent, shape, brain tissue reaction and ventricular pressure displacement of the tumor, but still need to be combined with clinical considerations, in order to confirm the diagnosis .
(6) Nuclear magnetic resonance: The diagnosis of brain tumor is more accurate than CT, the image is more clear, and tiny tumors that CT can not display can be found.
Diagnosis
Glioblastoma diagnosis and differentiation
diagnosis
According to their age, gender, location and clinical process, the pathological type is estimated. In addition to the medical history and neurological examination, some auxiliary examinations are needed to help diagnose the location and character.
(1) Cerebrospinal fluid examination: Most of the lumbar puncture pressure is increased. Some tumors such as the brain surface or the cerebral ventricle can increase the amount of protein in the cerebrospinal fluid, and the number of white blood cells can also increase. Some can find tumor cells, but the intracranial pressure is significantly increased. Lumbar puncture has the risk of promoting cerebral palsy, so it is generally only necessary when necessary. If it needs to be differentiated from inflammation or hemorrhage, the pressure should be increased. The operation should be cautious. Do not put more cerebrospinal fluid, and give mannitol drops after surgery. Note, pay attention to observation.
(2) Ultrasound examination: it can help to fix the side and observe the presence or absence of hydrocephalus. For infants, B-mode ultrasound scan can be performed through the anterior iliac crest, which can show tumor images and other pathological changes.
(3) EEG examination: EEG changes in gliomas are limited to changes in brain waves at the tumor site, and on the other hand are generally widely distributed frequencies and amplitude changes, which are affected by tumor size and infiltration. Sexuality, the degree of cerebral edema and increased intracranial pressure, shallow tumors are prone to localized abnormalities, while deep tumors are less limited, in benign astrocytoma, oligodendroglioma and other major manifestations For localized delta waves, some may have epileptic waves such as spikes or sharp waves. Large polymorphic glioblastomas can exhibit a wide range of delta waves, sometimes only on the side.
(4) Radioisotope scanning (Y-ray brain map): tumors with abundant growth and fast blood supply, high blood-brain barrier permeability, high isotope absorption rate, such as polymorphic glioblastoma showing isotope-concentrated images In the middle, there may be a low-density area due to necrosis and cyst formation. It needs to be differentiated from metastatic tumors according to its shape, multiple, etc. The amphoteric tumors and other benign gliomas have lower concentrations, often slightly higher than the surrounding. Brain tissue, the image is not clear, and some can be negative.
(5) Radiological examination: including cranial plain film, ventriculography, computed tomography, etc., cranial plain film can show increased intracranial pressure, tumor calcification and pineal calcification shift, ventricular angiography can show cerebral vascular migration Location and tumor vascular conditions, these abnormal changes, different types of tumors in different parts of the different types, can help to locate, and sometimes even qualitative, especially the CT scan has the greatest diagnostic value, intravenous contrast agent enhanced scan, positioning accuracy Almost 100%, the qualitative diagnosis accuracy rate can reach more than 90%, it can show the location, extent, shape, brain tissue reaction and ventricular pressure displacement of the tumor, but still need to be combined with clinical considerations, in order to confirm the diagnosis .
(6) Nuclear magnetic resonance: The diagnosis of brain tumor is more accurate than CT, the image is more clear, and tiny tumors that CT can not display can be found.
Positron emission tomography can obtain images similar to CT, and can observe the growth and metabolism of tumors and identify benign malignant tumors.
Differential diagnosis
It should be differentiated from meningioma, neurofibromatosis, acoustic schwannomas, and neurofibrosarcoma.
