brain stem tumor
Introduction
Brain stem tumor introduction The incidence of glioma in brain stem tumors is the highest, accounting for 40.49%, and the peak age of comprehensive onset is 30-40 years old, or 10-20 years old. Glioma in the cerebral hemisphere accounts for 51.4% of all gliomas, with astrocytoma being the most common, followed by glioma and oligodendroglioma. The ventricular system is also the site of glioma. , accounting for 23.9% of the total number of gliomas, mainly for meningioma, medulloblastoma, astrocytoma, cerebellar glioma accounted for 13% of the total number of gliomas, mainly astrocytoma. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: disturbance of consciousness
Cause
Brain stem tumor etiology
Seven emotions (55%):
The cause of the disease is not clear. The incidence of glioma in brain stem tumors is the highest, accounting for 40.49%. Chinese medicine believes that this disease is mostly caused by panic or anger, or depression and depression, making the blood and blood epidemic dysfunctional, weakening the resistance, and the disease and evil take advantage of it and become a cancer.
Pathogenesis
Brain stem tumors are mostly located in the pons, which are expansively growing and can extend up or down along the nerve fiber bundle. Astrocytoma can occur in any part of the brain stem, mostly invasive growth; ependymoma is mostly located in the bottom of the fourth ventricle; vascular reticuloma is expansive growth, can invade the dorsal medulla; cavernous hemangioma Mostly located in the pons. In general, it can be seen that the brain stem is symmetrical or asymmetrical, and the surface is grayish white or pink. If the tumor grows fast, the degree of malignancy is high, bleeding, necrosis, and even cystic deformation can be seen, and the cyst fluid is yellow. Microscopic examination showed that astrocytoma was more common in bipolar or unipolar astrocytes, and occasionally multinucleated giant cells.
1. Diffuse type (about 67%): There is no boundary between the tumor and the surrounding normal brainstem nerve tissue, and there are normal neuronal cells and axons between the tumor cells. The pathological type of tumor is often a different grade of astrocytoma (Grade I to IV).
2. Inflated type (about 22%): The tumor boundary is clear, and there is a dense tumor astrocyte axon layer (tumor membrane wall) between the tumor and the surrounding brainstem nerve tissue. The pathological type of tumor is mostly hair cell astrocytoma (Grade I), and about 40% of tumors contain vascular hamartoma, called astrocytoma.
3. Invasive type (about 11%): The tumor has a boundary with a naked eye, but in fact the tumor cells have invaded into the surrounding brainstem nerve tissue, and the nerve tissue has been completely destroyed by the tumor cells. The pathological type of tumor is more common in primitive neuroectodermal tumors.
Prevention
Brain stem tumor prevention
Pay attention to food hygiene and avoid carcinogens such as benzopyrene and nitrosamines from entering the body. Pay attention to personal hygiene, exercise, enhance resistance and prevent viral infection. Avoid brain trauma, and should be cured in time when brain trauma occurs. People who have had an intracranial tumor should not give birth again. In daily life, you should eat more yellow-green vegetables and fruits, such as carrots, pumpkins, tomatoes, lettuce, cabbage, spinach, jujube, bananas, apples, and mangoes.
Complication
Brain stem tumor complications Complications
The following complications often occur after brain stem tumor surgery:
Cranial nerve damage
Often for postoperative IX, X brain nerve damage is aggravated, patients with dysphagia cause respiratory infections, tracheotomy and nasal feeding are feasible to prevent infection and maintain nutrition.
2. Gastrointestinal bleeding
Brain stem surgery may cause gastrointestinal bleeding, especially in the medullary area. The literature reports that medullary vascular reticuloma has gastrointestinal bleeding after surgery, mostly in 4 to 5 days after surgery, lighter Can be automatically stopped, the heavy can last for several months, can be treated with drugs such as omeprazole.
3. Respiratory disorders
Frequently, the breathing slows or becomes shallower, which causes the blood oxygen partial pressure to decrease. At this time, the artificial synchronous ventilator can be used to assist the breathing and maintain the normal oxygen partial pressure.
4. Postoperative disturbance of consciousness
Often due to postoperative brain stem edema, postoperative dehydration agents and hormone therapy.
Symptom
Brain stem tumor symptoms common symptoms, pronunciation disorder, brain stem damage signs, pyramidal tract lesions, cerebellar signs, closed eyes, difficult to sign, cerebrospinal infiltration, hoarseness, gait, unstable, eyeball, tremor, eyeball
The clinical manifestations of tumors growing in the brainstem are closely related to the location, type and degree of malignancy of the tumor. The most common symptoms and signs are multiple cranial nerve damage, pyramidal tract signs and cerebellar signs. Patients with advanced disease may The table has an increased intracranial pressure.
Tumors in the midbrain are rare. In addition to gliomas, epithelioid cysts and vascular reticuloma are seen. Patients may have symptoms of ocular sacral palsy, such as drooping of the eyelids. Stenosis or atresia of the ventricle or midbrain aqueduct, early symptoms of increased intracranial pressure can occur, patients often have headaches, dizziness, restlessness and nausea and vomiting, with tumor compression and occupancy effects, Can present a typical clinical syndrome of midbrain damage.
The pons tumor often presents with intraocular oblique, diplopia, mouth sputum, facial numbness and other nerves, facial nerve or trigeminal nerve involvement symptoms; and sports, sensation and cerebellar symptoms, the increase of intracranial pressure in this part of the tumor appears later, Because the tumor is mostly invasive, the symptoms and signs are more complicated.
Medullary tumors have obvious symptoms and signs, such as bilateral lesions of the medulla oblongata, which can be manifested as bilateral cerebral palsy in the posterior group. Patients have swallowing and coughing, hoarseness, lingual paralysis and atrophy. With the development of tumors, When the pyramidal tract of the ventral aspect of the brain stem is involved, there is a cross sputum, which is manifested by ipsilateral cranial nerve palsy and contralateral limb muscle strength, increased muscle tone, hyperreflexia and pathological signs, and abnormalities of the limbs. Beginning with one lower limb, and then developing to the upper limb, but some slow-growing tumors often do not show early.
In the early stage of cerebral medullary tumor, there is no symptom of increased intracranial pressure, but intratumoral hemorrhage or cystic changes, affecting cerebrospinal fluid circulation, may increase intracranial pressure, therefore, for multiple cranial nerve damage or progressive cross palsy, accompanied by Patients with pyramidal tract signs should consider the possibility of tumors in this area. In addition, cerebellar signs are not uncommon, manifested as gait instability, closed eyes are difficult to sign positive, nystagmus and ataxia, and bilateral brains may appear in the late stage. Nerve involvement and pyramidal tract signs, some patients may also have forced head position due to tumor invasion of the medulla and upper cervical spinal cord.
Malignant diffuse tumors generally have a short course of disease and rapid development of the disease, accompanied by signs of severe brain stem damage, including cranial nerve palsy, but early signs of increased intracranial pressure are less common, and more often in the late stages of the disease.
The neurological impairment of inflated tumors usually progresses slowly. In some cases, the signs of focal lesions in the brain stem are very mild, and the midbrain tumors can have many different manifestations of limb paralysis.
Most patients with brain stem tumors have slow onset, headache is not obvious, and cerebral nerve palsy is gradually appearing. Among them, paralysis of the nerves is more common, and later facial paralysis, difficulty in swallowing, dysphonia, pyramidal tract damage, gait instability and Ataxia, etc., typical cases often show cross-paralysis, CT scan and MRI can help doctors determine the type of tumor growth.
Examine
Brain stem tumor examination
Lumbar puncture cerebrospinal fluid pressure and cell count are mostly normal, and a small number of patients have increased protein content. It is generally believed that lumbar puncture results have little effect on the diagnosis of brain stem tumors.
1. Skull X-ray film
There is no change, so there is no increase in intracranial pressure in early patients.
Brainstem auditory evoked potential
Brainstem auditory evoked potentials combined with other auditory function tests are more helpful in accurately diagnosing tumor sites.
3.CT scan
Usually, brain stem glioblastoma is more common in low-density foci and brainstem swelling. A few of them have equal density or slightly high density, and the cysts become very small. Upward can invade the hypothalamus, and can develop to the pons and cerebellum. Hemisphere, intensive scanning may have uneven enhancement or ring enhancement, cavernous hemangioma is uniform high density in the acute phase of hemorrhage; low density in subacute and chronic phase, ependymoma is high density, can enhance, blood vessels Reticuloma is highly dense and significantly enhanced. The tuberculosis sphere is ring-shaped and high-density, and the central part is low-density. It can be significantly enhanced. To distinguish brain stem tumors from extracerebral stem tumors, cerebral angiography CT scans and CT scans are necessary. Brain stem tumors can be divided into 3 types: type I is a non-enhanced lesion, which is characterized by low-density lesions; type II diffuse enhancement; type III is a ring-shaped enhancement, of which type I is more common, and type II and type III are less common.
4. MRI examination
Brain stem glioblastoma often shows long T1 and long T2 signal changes, no cystic changes or hemorrhage, borders are generally unclear, irregular morphology, most tumors have Gd-DTPA enhancement, compared with CT scan, due to its multiple viewing angles Imaging and non-cranial bottom bone artifact interference can more clearly show the lesion location and extent. Cavernous hemangioma is uniform and high density in the acute phase of hemorrhage T1Wl and T2Wl, with clear outline and often round, in Asia. Both acute and chronic T1Wl and T2W1 are also high-density. The ependymoma is long T1 and long T2. It develops to the fourth ventricle or cerebellar pons, and the vascular reticuloma is long T1 and long T2. The spherical shape is located behind the medulla, and the tuberculosis sphere is a ring-shaped high density, which is more remarkable after strengthening, and the middle is low density.
Diagnosis
Brain stem tumor diagnosis and differentiation
diagnosis:
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis:
Glioblastoma derived from the brain stem is more common and needs to be differentiated from the following lesions, including brain stem hematoma, hemangioblastoma, metastases, cholesteatoma and granuloma, etc. Brain stem tumors should also be associated with brain stem encephalitis. Differentiation is difficult to identify based on clinical symptoms and signs. Sometimes CT or MRI shows similar changes, which is difficult to differentiate, but brain stem and encephalitis can be relieved by clinical application of hormones, dehydration and anti-inflammatory symptoms. However, although the symptoms of brainstem tumors can be temporarily relieved, the overall condition is progressively aggravated. When the nature of brainstem lesions is not well defined, it can be confirmed by direct surgery or stereotactic surgery.
