126:) astrocytoma/oligodendroglioma are among the worst. In these cases, untreated survival usually amounts to only a few months, and survival with current radiation and chemotherapy treatments may extend that time from around a year to a year and a half, possibly two or more, depending on the patient's condition, immune function, treatments used, and the specific type of malignant brain neoplasm. Surgery may in some cases be curative, but, as a general rule, malignant brain cancers tend to regenerate and emerge from
153:
248:. The rapid growth of fast-growing high-grade brain tumors may damage the subcortical network essential for electrical transmission, whereas slow-growing tumors have been suggested to induce partial deafferentation of cortical regions, causing denervation hypersensitivity and producing an epileptogenic milieu. Studies strongly suggest that genetic factors may play a role in tumor development and tumor-related epilepsy.
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Accurate histologic diagnosis is critical for treatment planning and patient counseling. Surgically obtained tissue usually is required to make a histologic diagnosis. For certain tumors, a definitive diagnosis can be accomplished by vitreous aspirate, cerebrospinal fluid (CSF) cytology, or suggested
352:
The initial evaluation of a patient with a newly diagnosed tumor of the nervous system is a critical step toward appropriate management and patient care. The most important portions of the initial evaluation are a detailed history and a thorough examination. This process serves to identify the extent
148:
Primary brain tumors can occur at any age, from infancy to late in life. These tumors often afflict people during their prime years. Factors such as age, tumor location, and clinical presentation are helpful in differential diagnosis. Most types of primary brain tumors are more common in men with the
463:
Chemotherapy, or the use of drugs in the treatment of cancer, can lead to the long-term control of many malignancies. Some tumors, such as testicular cancer of
Hodgkin's disease, may be cured even when they are widespread. As chemotherapy may be associated with severe toxicity, it should be given
197:
and associated neurologic symptoms. These processes tend to cause seizures early in the course because of their cortical location. Metastasis to the leptomeninges is an uncommon but well-recognized clinical presentation in cancer patients. Leptomeningeal metastasis most commonly is due to breast,
478:
Neurosurgical intervention is warranted in almost all cases of primary central nervous system tumors and for many metastatic tumors. A biopsy usually establishes a definitive histologic diagnosis. The role of surgery depends on the nature of the tumor. With modern neurosurgical techniques, most
256:
Recent work has demonstrated a close link between seizure activity and high extracellular glutamate in tumor-related epilepsy. Glutamate activation of ionotropic receptors leads to a rapid excitatory signal based on cation influx that can cause release of calcium from intracellular stores.
362:
There is no question that the clinical management of neurooncology patients is challenging. However, if we are to help patients and ultimately make advances in treating these tumors, meticulous and compassionate care of patients with neurological malignancies are crucial.
193:. Brain metastasis can be single or multiple and involve any portion of the brain. Metastasis to dural structures generally occurs by hematogenous spread or direct invasion from a contiguous bone. Dural metastases can invade the underlying brain and cause focal
271:
In general, patients with primary brain tumors or single metastatic tumors can present with any of these signs and symptoms, whereas patients with multiple brain metastases tend to present with generalized symptoms and may lack localized findings.
130:
easily, especially highly malignant cases. In such cases, the goal is to excise as much of the mass (tumor cells) and as much of the tumor margin as possible without endangering vital functions or other important cognitive abilities. The
165:
Cancer spreads to the nervous system by direct invasion, compression, or metastasis. Direct invasion or compression from continuous tissues relates to the proximity of the nervous system to other structures, such as the
684:
Muller, H. L., Gebhardt, U., Warmuth-Metz, M., Pietsch, T., Sorensen, N., & Kortmann, R. D. (2012). Meningioma assecond malignant neoplasm after oncological treatment during childhood. 188, 438-441. Retrieved from
279:
Seizures (partial or generalized) are the presenting symptom in 15-20% of patients with intracranial tumors. Seizures occur in up to 50% of patients with melanoma metastases, oligodendrogliomas, and tumors that have a
341:
Changes in bowel and bladder habits, particularly urinary retention with overflow incontinence, usually occur late in the course of epidural spinal cord compression but are seen in a small percentage of patients at
457:
Radiotherapy is an important treatment for central nervous system tumors and has been demonstrated to extend survival and improve the quality of life for patients with many of the primary and metastatic brain
210:
and skull base. Metastases to the calvarium usually are asymptomatic. Metastases to the skull base quickly become symptomatic because of their proximity to cranial nerves and vascular structures.
353:
and nature of neurological deficit, provides diagnostic clues, can help disclose a source of metastasis, or may identify a genetic process associated with a primary central nervous system tumor.
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Corticosteroids (CS) are commonly used in patients with a variety of neuro-oncologic conditions. CS treatment often is required to control symptoms related to increased
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Although intratumoral hemorrhage can occur in any primary or metastatic brain tumor, certain tumors have a greater tendency to bleed, including metastasis from melanoma,
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222:
space. This usually occurs as direct tumor spread from a vertebral body (85%) or by invasion of paravertebral masses through a neuroforamin (10–15%).
135:
is the longest continuously published journal in the field and serves as a leading reference to those practicing in the area of neuro-oncology.
861:
555:
Smits, A. (2011). Seizures and the natural history of World Health
Organization grade II gliomas: a review. Neurosurgery (2011): 1326-1333.
437:(CSF) analysis are important for the evaluation of some primary tumors, metastatic conditions, and neurologic complications of cancer.
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Pain is the first symptom in >90% of patients presenting with epidural metastasis and occurs less frequently with intradural tumors.
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565:
Read, Tracy-Ann; Hegedus, Balazs; Wechsler-Reya, Robert; Gutmann, David H. (July 2006). "The neurobiology of neurooncology".
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Pain occasionally can be absent in adults and more often is absent in childhood. If other neurologic symptoms suggestive of
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639:"Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note"
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Duffau, H. (2012). The challenge to remove diffuse low-grade gliomas while preserving brain functions. 10(7), 569-574.
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Use a consistent format of written instructions, so that a patient can expect where to find information on the page.
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110:, and brain stem tumors are among the many examples of these). Among the malignant brain cancers, gliomas of the
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Seizures are common in patients with low-grade tumors such as dysembryoblastic neuroepithelial tumors,
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patients with extra-axial brain tumors are cured with minimal residual neurologic deficit.
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Liu, James K.; Patel, Smruti K.; Podolski, Amanda J.; Jyung, Robert W. (September 2012).
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under the supervision of one skilled in the administration and monitoring of such agents.
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A team approach, using clinicians with different areas of expertise, is helpful.
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Give instructions both orally and in written form for the patient to take home.
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are present, without pain, the clinician should evaluate for spinal cord tumor.
90:, many of which are (at least eventually) very dangerous and life-threatening (
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Ansari, Shaheryar F.; Terry, Colin; Cohen-Gadol, Aaron A. (September 2012).
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Write down new or important diagnoses for the patient to refer to at home.
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Metastases to the skull are divided into two categories by general site:
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component. Seizures also are more common with cortically based tumors.
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McAllister, L.D., Ward, J.H., Schulman, S.F., DeAngels, L.M. (2002).
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The spine most often is affected by metastatic disease involving the
174:, vertebral neuroforamina, base of skull, cranium, and pelvic bones.
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Provide a reliable and simple method for the patient to seek help.
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Identify one reliable caregiver to serve as a contact point.
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Practical
Strategies for Providing Appropriate Patient Care
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exception of meningiomas, which are more common in women.
497:
Levin, VA (April 1999). "Neuro-oncology: an overview".
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The imaging studies commonly used in neurooncology are
830:– Trusted evidence. Informed decisions. Better health.
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by the presence of certain tumor markers in the CSF.
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275:Several clinical features warrant special comment:
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544:Practical Neuro-Oncology: A Guide to Patient Care.
182:There are three types of intracranial metastasis:
426:Lumbar puncture and cerebrospinal fluid analysis
398:Diagnostic imaging of the brain and spinal cord
287:Seizures are much less common in patients with
161:Metastatic tumors of the central nervous system
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331:, dura, nearby soft tissues, and nerve roots.
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1390:Intraoperative neurophysiological monitoring
144:Primary tumors of the central nervous system
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824:– British Neuro-Oncology Society (BNOS)
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323:Mechanisms of pain include spinal cord
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261:Initial patient evaluation and care
546:Woburn, MA: Butterworth-Heinemann.
379:Pictures and diagrams are helpful.
198:lung, or melanoma primary tumors.
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1370:Development of the nervous system
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757:"Neuroimaging in neuro-oncology"
315:Spinal Cord Tumor Presentations
118:, glioblastoma multiforme, and
410:(MRI). Less commonly used are
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1211:Social cognitive neuroscience
1186:Molecular cellular cognition
836:– Society for Neuro-Oncology
476:Neurosurgical interventions
416:positron emission tomography
156:Human Central Nervous System
1405:Neurodevelopmental disorder
1380:Neural network (biological)
1375:Neural network (artificial)
473:(ICP) or peritumoral edema.
388:Minimize sedating drug use.
252:Glutamate neurotransmission
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932:Computational neuroscience
773:10.1016/j.nurt.2009.05.002
755:Cha, Soonmee (July 2009).
408:magnetic resonance imaging
291:tumors than in those with
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1400:Neurodegenerative disease
1244:Evolutionary neuroscience
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725:10.3171/2012.6.FOCUS12163
656:10.3171/2012.6.FOCUS12168
511:10.1001/archneur.56.4.401
267:Brain Tumor Presentations
133:Journal of Neuro-Oncology
1365:Brain–computer interface
1314:Neuromorphic engineering
1239:Educational neuroscience
1146:Nutritional neuroscience
1051:Clinical neurophysiology
947:Integrative neuroscience
450:Commonly used treatments
186:, dural metastasis, and
21:Neuro-Oncology (journal)
1176:Behavioral neuroscience
178:Intracranial metastasis
100:glioblastoma multiforme
1171:Affective neuroscience
952:Molecular neuroscience
907:Behavioral epigenetics
418:(PET), and diagnostic
157:
1234:Cultural neuroscience
1229:Consumer neuroscience
1071:Neurogastroenterology
927:Cellular neuroscience
834:www.soc-neuro-onc.org
499:Archives of Neurology
471:intracranial pressure
393:Diagnostic procedures
302:from systemic cancer.
155:
88:spinal cord neoplasms
19:For the journal, see
1206:Sensory neuroscience
1046:Behavioral neurology
1017:Systems neuroscience
441:Pathologic diagnosis
327:and traction on the
1349:Social neuroscience
1249:Global neurosurgery
1126:Neurorehabilitation
1096:Neuro-ophthalmology
1081:Neurointensive care
912:Behavioral genetics
712:Neurosurgical Focus
643:Neurosurgical Focus
567:Annals of Neurology
435:cerebrospinal fluid
404:computed tomography
139:General information
28:
1425:Neuroimmune system
1319:Neurophenomenology
1259:Neural engineering
982:Neuroendocrinology
962:Neural engineering
246:oligodendrogliomas
172:lumbosacral plexus
158:
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1344:Paleoneurobiology
1279:Neuroepistemology
1254:Neuroanthropology
1220:Interdisciplinary
1106:Neuropharmacology
1066:Neuroepidemiology
761:Neurotherapeutics
579:10.1002/ana.20912
214:Spinal metastasis
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461:Chemotherapy
460:
455:Radiotherapy
454:
453:
449:
447:
440:
438:
436:
432:
425:
423:
421:
417:
413:
409:
405:
397:
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359:
354:
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342:presentation.
340:
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286:
283:
278:
277:
276:
273:
269:
268:
260:
258:
251:
249:
247:
243:
242:gangligliomas
235:
231:Tumor factors
230:
225:
223:
221:
213:
211:
209:
201:
199:
196:
192:
189:
185:
177:
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109:
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101:
97:
93:
89:
85:
81:
72:
68:
65:
61:
57:
53:
52:Tumor markers
50:
43:
40:
39:
34:
30:
22:
1484:
1472:
1420:Neuroimaging
1415:Neurogenesis
1299:Neurohistory
1264:Neurobiotics
1163:neuroscience
1131:Neurosurgery
1090:
1056:Epileptology
1038:neuroscience
1007:Neurophysics
997:Neurometrics
972:Neurobiology
967:Neuroanatomy
937:Connectomics
871:Neuroscience
764:
760:
750:
715:
711:
646:
642:
570:
566:
560:
551:
543:
505:(4): 401–4.
502:
498:
492:
444:
429:
401:
361:
357:
355:
351:
347:
345:
314:
312:
274:
270:
266:
264:
255:
239:
217:
205:
181:
164:
147:
79:
78:
45:Significant
38:brain tumors
35:
1289:Neuroethics
1136:Neurotology
573:(1): 3–11.
420:angiography
412:myelography
282:hemorrhagic
92:astrocytoma
56:TNM staging
1502:Categories
1450:Neurotoxin
1151:Psychiatry
718:(3): E14.
649:(3): E17.
484:References
336:myelopathy
329:periosteum
226:Mechanisms
191:metastasis
124:anaplastic
120:high-grade
104:ependymoma
70:Specialist
36:Cancerous
1508:Neurology
1395:Neurochip
1161:Cognitive
1086:Neurology
433:(LP) and
406:(CT) and
236:Histology
208:calvarium
128:remission
112:brainstem
1513:Oncology
1474:Category
1358:Concepts
1304:Neurolaw
1036:Clinical
791:19560737
742:46630604
734:22937848
665:22937851
587:16802285
519:10199326
325:ischemia
220:epidural
122:(highly
60:CT scans
1486:Commons
899:science
887:History
882:Outline
782:5084183
458:tumors.
300:embolus
295:tumors.
1222:fields
789:
779:
740:
732:
663:
595:870084
593:
585:
517:
244:, and
96:glioma
897:Basic
738:S2CID
591:S2CID
195:edema
84:brain
47:tests
32:Focus
787:PMID
730:PMID
661:PMID
583:PMID
515:PMID
116:pons
114:and
86:and
777:PMC
769:doi
720:doi
651:doi
575:doi
507:doi
356:4.
346:3.
313:2.
265:1.
64:MRI
1504::
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509::
23:.
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