intracranial tumor
Introduction
Introduction to intracranial tumors Intracranial tumors are tumors that grow in the brain and are commonly referred to as brain tumors, including primary brain tumors that occur from the brain parenchyma and secondary brain tumors that are transferred from other parts of the body to the brain. The cause is still unknown. Tumors originate from the brain, meninges, pituitary gland, cranial nerves, cerebrovascular and embryonic residual tissues, and are called primary intracranial tumors. A malignant tumor organized by other organs of the body is transferred to the intracranial, called a secondary intracranial tumor. Intracranial tumors can occur at any age and are most common in the 20 to 50 years old. One of the more common tumors in childhood, because the children with intracranial tumors are more malignant and the location of benign tumors is difficult and difficult to remove, it often endangers the lives of children. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: nystagmus, precocious puberty, epilepsy, cerebral palsy
Cause
Intracranial tumor cause
Genetic factors (20%):
In the field of neurosurgery, some tumors have obvious family predispositions, such as retinoblastoma, vascular reticuloma, multiple neurofibromas, etc., which are generally considered to be autosomal dominant hereditary tumors. The rate is very high.
Physical and chemical factors (30%):
Among the physical factors that have been confirmed to be tumor-causing, there are many reports of intracranial tumors caused by cranial radiotherapy. Among chemical factors, polycyclic aromatic hydrocarbons and nitric acid compounds such as methylcholanthrene and benzene Compared with methylnitrosourea and nitrosopiperidine, brain tumors can be induced in some animal experiments.
Viral infection (20%):
Experimental studies have shown that some viruses, including DNA viruses and RNA viruses, can induce brain tumors if inoculated into the brain of animals.
Immunosuppression (5%):
The use of organ transplant immunosuppressive drugs increases the risk of intracranial or peripheral tumors.
Residual embryos (2%):
Craniopharyngioma, epithelioid and dermoid cysts, teratomas, and chordomas occur in embryonic tissues that remain in the brain. These residual tissues have the potential to proliferate and differentiate, and can develop into tumors under certain conditions.
Pathogenesis:
Classification: There are many methods for classification of intracranial tumors in the central nervous system. The representative ones are mainly the following. The classification of Bailey and Cushing can reflect the source and malignancy of tumor tissues, and has long been the Department of Neurosurgery and Pathology in most parts of the world. Based on this, some new classification methods have been derived, such as Kernohan's I-IV classification, Russell's glioma classification, and more influential is that Kernohan proposed to include gliomas, including astrocytomas. Oligodendroglioma, ependymoma and neurogenic tumors are classified into grades I-IV according to their degree of differentiation. According to this classification, it seems that the development of tumors and the prognosis of patients can be easily judged, so they are welcomed by clinicians. It has been used domestically and internationally for many years, but this classification method is also flawed. For example, the same tumor can be differentiated in different parts of the tumor. Some mixed tumors cannot be graded, and some tumors have little meaning. On this basis, the World Health Organization has formulated The new taxonomy, which is characterized by careful classification, includes various types of tumors that occur in the brain, and absorbs various classifications in the past. Features and advantages, both to reflect the tumor morphology, but also indicate the source of the tumor, and the use of change between this concept can be considered as the best classification.
Prevention
Intracranial tumor prevention
This disease has not been clearly defined the cause of the disease, with reference to the general tumor prevention methods, to understand the risk factors of the tumor, the development of appropriate prevention and treatment strategies can reduce the risk of cancer, prevention of tumor occurrence has two basic clues, even if the tumor has begun to form in the body They can also help the body to increase its resistance. These strategies are as follows:
1. Avoid harmful substances (promoting factors): It can help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors: can help to strengthen and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens, but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains only 50mg of vitamin C and 13u of vitamin E, but its antioxidant activity is equivalent to 800mg of vitamin C and 1100u of vitamin E antioxidant activity, it can be inferred that the antioxidant effect in fruits and vegetables is far more than we know The effect of vitamins is strong, and no doubt natural plant products will help future cancer prevention work.
Complication
Intracranial tumor complications Complications, nystagmus, precocious puberty, cerebral palsy
Local symptoms vary depending on the location and size of the tumor. Cerebral hemisphere tumors near the central anterior and posterior gyrus may have weak or partial hemiplegia; affecting the language center may have motor or sensory aphasia; the sellar tumor may have optic nerve origin Sexual atrophy and vision, visual field changes; tumor affects the pituitary - hypothalamus may have growth and development disorders, obesity or weight loss, polydipsia and body temperature regulation disorders; under the tumor more gait instability, nystagmus, muscle tension and paralysis Reflex decline; brain stem tumors have cranial nerve damage and contralateral pyramidal tract signs; pineal tumors have eyeball difficulty and precocious puberty, often complicated by epilepsy, cerebral palsy.
Symptom
Intracranial tumor symptoms Common symptoms Recurrent headache Skull hyperplasia Increased intracranial pressure Increased intracranial pressure Functional headache Consciousness Frontal mass Hydrocephalus Paralysis Double vision
Pediatric intracranial tumors occur in the midline and posterior fossa, so it is easy to block the cerebrospinal fluid circulation pathway early, and there are important structures such as increased intracranial pressure and pressure brainstem. The course of disease is often shorter than that of adults. At the same time, due to incomplete development of children's skull, generations The ability to pay is stronger than that of adults, so the symptoms of localized nervous system damage are relatively less than that of adults, mainly due to increased intracranial pressure. Common symptoms are as follows:
General symptoms
Increased intracranial pressure in children can be expressed as irritability and irritability, while some are indifferent or lethargic. If there is a disturbance of consciousness, slow pulse, slow breathing, high blood pressure indicates that it has entered the early stage of cerebral palsy, need to do emergency reduction of intracranial pressure, children The intracranial pressure compensatory ability is higher than that of adults, and the increase of intracranial pressure occurs later. Once decompensation, the condition deteriorates sharply, so early diagnosis is very important.
Vomiting
About 70% to 85% of children have vomiting, which is caused by increased intracranial pressure or posterior fossa tumor directly stimulating the medullary vomiting center. In some children (about 10% to 20%) vomiting is the only early symptom. Among them, infants and young children are more common, vomiting can be accompanied by headache or dizziness, vomiting is not all jetting, more common in the morning or after breakfast, often can eat immediately after vomiting, and then quickly vomiting, a small number of children can accompany Have abdominal pain, early misdiagnosis as a gastrointestinal disorder.
3. headache
70% to 75% of children have headaches, the on-screen tumor headache is mostly in the forehead, and the under-the-slice tumor is mostly in the occipital region, mainly due to increased intracranial pressure or brain tissue displacement, causing meningeal, vascular or cranial nerve tension traction. As a result, the headache may be intermittent or persistent, and gradually increase with the prolongation of the course of the disease, but when the visual loss is more obvious, the infant can not complain of headache, and can express both hands, scratching his head or bursting into tears. It should be taken seriously for children's headaches because there are few functional headaches in this age group.
4. Visual impairment
Vision loss can cause primary optic nerve atrophy due to direct compression of the visual pathway in the sellar region. It is more due to secondary optic atrophy caused by optic disc edema due to increased intracranial pressure. Optic disc edema depends on the location, nature and duration of the tumor. The posterior fossa tumor is larger and heavier in the hemisphere. The higher the malignant degree or the longer the course of the tumor, the more obvious the optic disc edema. Children's vision loss is easily ignored by the parents. Therefore, there are less than 40% of the chief complaints. In 10% of the children, the eyes were nearly blind or blind. In this group, 2,000 patients with optic disc edema accounted for 75%, the optic nerve atrophy was 8.4%, the visual field changed less, and the larger tumor in the sellar region. There may be bilateral sacral hemianopia; in the late stage of optic disc edema, there may be a reduction in visual field centripetality, but pediatric visual field examination often fails to cooperate.
5. Head enlargement
Head enlargement and broken pot sound (McCewen sign) positive, more common in infants and younger children, due to incomplete cranial suture healing or fibrous healing, increased intracranial pressure can cause cranial suture separation head circumference increased, percussion can be Smell and broken pot sound, this group of head enlargement accounted for 48.9%, infants within 1 year old can also see anterior sacral bulging and scalp venous engorgement, but not as serious as congenital hydrocephalus, the tumor is located in the cerebral hemisphere convex is still visible The skull is locally raised and the appearance is asymmetrical.
6. Neck resistance or forced head position
Pediatric intracranial tumors are more common in this manifestation. The third ventricle tumor can be in the knee chest position, and the posterior fossa tumor is skewed to the affected side to keep the cerebrospinal fluid circulating smoothly. It is a kind of protective reflection of the body. Resistance is more common in posterior fossa tumors, due to chronic cerebellar tonsillar sacral or tumor growth and compression of the upper cervical nerve root. For such patients to prevent the occurrence of occipital foramen magnum, early ventricular puncture drainage or Dehydration drugs reduce intracranial pressure.
7. Seizures
The incidence of epilepsy in children with brain tumors is lower than that of adults. The reasons are: there are more tumors under the eyes of children; and more common malignant tumors, more symptoms of brain tissue damage than irritation, this group of epilepsy authors accounted for 10%.
8. fever
The history of fever in the course of the disease is a characteristic manifestation of pediatric brain tumors. The incidence rate of this group is 4.1%, which is related to the more malignant brain tumors in children and the instability of body temperature regulation.
9. Double vision and strabismus in the eye
Mostly caused by increased intracranial pressure caused by nerve palsy, can occur at the same time, mostly bilateral.
Examine
Examination of intracranial tumors
Lumbar puncture examination should be classified as contraindication for children with optic disc edema, which can induce cerebral palsy. When the child is crying, the pressure measurement is often inaccurate. The "white blood cells" of cerebrospinal fluid in children with brain tumors can be increased, but it should be differentiated from the shed tumor cells. The protein is increased and the sugar and chloride are normal, which is different from the inflammatory response.
1. Skull X-ray film
To understand whether there is an increase in intracranial pressure (cranial suture separation and increased finger pressure), and whether there are abnormal calcifications (more common in craniopharyngioma and oligodendroglioma).
2. Cerebral angiography
When the tumor has a mass effect, the blood vessel is displaced; the tumor with abundant blood supply can be stained with abnormal tumor.
3. Computerized tomography (CT)
Not only can you accurately locate, but you can also understand the size of the tumor, the solidity of the capsule, the presence or absence of calcification, the richness of blood supply and the peritumoral edema.
4. Magnetic resonance imaging (MRI)
With sharper contrast and better anatomical background, it is particularly clear for midline and posterior fossa tumors, but not as good for calcification and bone.
Diagnosis
Diagnosis and diagnosis of intracranial tumor
diagnosis
When children have recurrent episodes of headache and vomiting without obvious causes, the possibility of intracranial tumors should be considered. Do not relax the symptoms due to symptom relief. Careful neurological examination should be performed for children with suspected intracranial tumors. Discretionary brain X-ray, brain CT, MRI and other auxiliary examinations should be performed as appropriate.
Differential diagnosis
Children with poor expression ability and poor development of the nervous system or uncooperative physical examination, symptoms and signs can not be obvious, and many symptoms similar to other children's diseases, or after other diseases, it is easy to misdiagnosis, should be highly valued, Pediatric brain tumors are most easily misdiagnosed as the following diseases:
1. Meningitis or encephalitis
Because of the fever of children with brain tumors accounted for 4.1%; cerebrospinal fluid can be inflammatory-like changes and combined with cerebellar tonsillar sputum as a neck resistance, clinically misdiagnosed as tuberculous or suppurative meningitis.
2. Gastrointestinal disorders
When the intracranial pressure is increased, the child has vomiting after repeated eating, and is easily misdiagnosed as gastroenteritis or pyloric obstruction and intestinal ascariasis.
3. Congenital hydrocephalus
The head enlargement of infantile brain tumors, high anterior tendon tension and scalp venous engorgement are similar to hydrocephalus, but the following characteristics are helpful for identification. The onset of hydrocephalus is earlier than that of intracranial tumors. Increase; obvious eyeball fall sign; optic disc more edema; less vomiting symptoms.
4. Neurological headache
Pediatric headaches are mostly organic lesions, and should be further examined.
5. Diabetes insipidus
Mostly a symptom of a saddle area tumor rather than a disease.
6. Ophthalmological diseases
Brain tumor caused by optic disc edema and secondary optic atrophy can affect the visual field of vision, easily misdiagnosed as optic discitis or optic neuritis, medical history and auxiliary examination can help identify.
7. Epilepsy
About 10% of children with brain tumors have seizures, and only the exclusion of tumors and vascular lesions can make a diagnosis of primary epilepsy.
8. Cerebellar ataxia
It is a degenerative lesion of the cerebellum, and the progression is slow and no increase in intracranial pressure can be distinguished from posterior fossa tumors.
