Malignant Brain Tumours

Pineocytoma.- Pineoblastoma.- Mixed pineocytoma/pineoblastoma.- Embryonal tumours (neuroimaging correlations).- Medulloepithelioma.- Neuroblastoma.- Ependymoblastoma.- Retinoblastoma.- Medulloblastoma.- Tumours of the meninges.- Tumours of meningothelial cells.- Meningioma.- Atypical meningioma.- Anaplastic (malignant) meningioma.- Papillary meningioma.- Mesenchymal, non-meningothelial tumours.- Haemangiopericytoma.- Tumours of uncertain histogenesis.- Haemangioblastoma.- References.- Colour plate section appears between pages 42 and 43.- 4 General Introduction to the Clinical Features of Malignant Brain Tumours.- Epidemiology.- Clinical presentation of primary malignant brain tumours.- Symptoms and signs of raised intracranial pressure.- Epilepsy.- Focal signs.- Specific clinical syndromes.- Glioblastoma.- References.- 5 Complications of Primary Malignant Brain Tumours.- Complications of the tumour itself.- Raised intracranial pressure.- Clinical effects.- Brain compliance.- Tumour volume.- Brain oedema.- Hydrocephalus.- Pathology of intracranial expanding lesions.- Supratentorial expanding lesions: supracallosal hernia; tentorial hernia; central transtentorial hernia; haemorrhage and infarction in the midbrain and pons.- Infratentorial expanding lesions: tonsillar hernia.- Other features: pressure effects upon the skull; external herniation; pituitary.- Focal or site-specific complications.- Epilepsy.- Focal neurological deficit.- Spontaneous haemorrhage.- Metastasis of primary brain tumours.- Complications of treatment.- Surgery.- Risks and benefits.- Freehand biopsy.- Stereotaxic biopsy.- Internal decompression of tumour.- Radiotherapy.- Acute reactions.- Early delayed reactions.- Late delayed reactions: radionecrosis; diffuse leucoencephalopathy; intellectual deficits; hypothalamic-pituitary dysfunction; blindness; induction of brain tumours; alternative techniques of focused radiation.- Chemotherapy: systemic complications; CNS complications; acute cerebellar syndrome; acute encephalopathy; chronic encephalopathy; neuropathology of disseminated necrotizing leucoencephalopathy; osmotic blood-brain barrier opening; other complications of antineoplastic agents.- Steroids.- References.- 6 Low-grade Gliomas.- Low-grade cerebral astrocytoma.- Incidence.- Patient series.- Clinical presentation.- Special features.- Development of malignancy.- Infiltration of astrocytomas.- Neurosurgical management.- Expectant management.- Biopsy.- Stereotaxic biopsy.- Open biopsy.- Removal of tumour.- Stereotaxic resection of low-grade astrocytoma.- Non-stereotaxic resection of low-grade astrocytoma: rehearsal of surgical procedure; placement of craniotomy; ultrasound imaging; microsurgical dissection.- Evaluation of surgical results.- Future Considerations.- Acknowledgements.- References.- 7 Management of Brain Tumours in Childhood.- Introduction: the sites; the cells; the patients.- Primitive neuroectodermal tumour (PNET).- Surgery.- Radiation therapy.- Chemotherapy.- Brain stem glioma.- Craniopharyngioma.- Surgery.- Radiation therapy.- Chemotherapy.- Conclusion.- Ependymoma.- Surgery.- Radiation therapy and chemotherapy.- Pineal region tumours.- Radiation therapy and chemotherapy.- Conclusion.- References.- 8 Central Nervous System Neoplasms in Acquired Immunodeficiency Syndrome.- Primary CNS lymphoma.- Clinical manifestations.- Pathology.- Treatment and prognosis.- Systemic non-Hodgkin's lymphoma.- Clinical manifestations.- Pathology.- Treatment and prognosis.- Kaposi's sarcoma.- Pathogenesis of neoplasms in immune deficiency.- References.- 9 Metastatic Brain Tumours.- General aspects.- Primary tumours.- Sites of metastatic involvement.- Histological diagnosis.- Age and sex.- Signs and symptoms.- Neurological symptoms.- Time of onset.- Investigations.- Computed tomography scan.- Magnetic resonance imaging.- Angiography.- Electroencephalography.- Cytological examination of cerebrospinal fluid.- Tumour markers.- Treatment.- Surgery.- Indication.- Preoperative management.- Surgical technique.- Postoperative care.- Radiotherapy.- Chemotherapy.- Biological response modifiers.- Outcome of treatment.- References.- 10 Diagnostic Imaging of Brain Tumours.- Detection of an abnormality.- Computed tomography and magnetic resonance imaging.- Fluid.- Calcification.- Haemorrhage.- Oedema.- Contrast enhancement.- Mass effect of tumours.- Localization and assessment of extent of abnormality.- Supratentorial masses.- Cerebellar masses.- Brain stem tumours.- Characterization of a lesion.- Glial tumours.- Infarction.- Intracerebral haemorrhage.- Cerebral abscess.- Granuloma.- Opportunistic infection.- Progressive multifocal leucoencephalopathy.- Herpes simplex virus encephalitis.- Parasitic infections.- Hydatidosis.- Cysticercosis.- Paragonimiasis, schistosomiasis.- Extrinsic tumours.- Meningioma.- Epidermoid.- Cholesterol granuloma.- Dermoid.- Parasellar tumours (intrinsic and extrinsic).- Chordoma, chondroma, chondrosarcoma.- Neurinoma.- Paraganglioma.- Extrinsic malignancies.- Sphenoid mucocele.- Subdural and extradural empyema.- Meningeal infiltration.- Intracerebral metastasis.- Imaging characteristics of intrinsic tumours.- Anaplastic or malignant astrocytoma - grades III and IV.- Benign astrocytoma - grades I and II.- Subependymal giant cell astrocytoma.- Lhermitte-Duclos disease.- Ganglioglioma.- Hamartoma.- Ependymoma.- Oligodendroglioma.- Malignant lymphoma.- Primitive neuroectodermal tumour.- Classical medulloblastoma.- Adult medulloblastoma.- Congenital medulloblastoma.- Supratentorial neuroectodermal tumour.- Colloid cyst.- Choroid plexus papilloma.- Intraventricular meningioma.- Pineal region tumour.- Germinoma.- Pineal teratoma.- Pineocytoma.- Pineal astrocytoma.- Haemangioblastoma.- Multiple primary brain tumours.- Cavernous haemangioma.- Neuroblastoma.- Facilitation of treatment and further surgical planning.- Monitoring of therapy and outcome of treatment.- Surgery.- Radiotherapy.- References.- 11 Surgery for Primary Malignant Brain Tumours.- Historical introduction.- Principles of surgery.- Establishment of diagnosis.- Cytoreduction and alteration of tumour kinetics.- Relief of symptoms and improvement in survival.- Principles of perioperative care.- Surgical methods.- Methods of establishing tissue diagnosis.- Freehand biopsy.- Image-guided stereotaxic biopsy.- Ultrasound-guided biopsy.- Methods of tumour resection.- Principles of craniotomy: positioning and exposure; identification of tumour and resection.- Lobectomy as a method of resection: frontal; temporal; occipital.- Additional surgical methods.- Surgical treatment of gliomas within a specific site.- Recent advances in surgical methods.- Operating microscope.- Lasers.- Ultrasonic surgical aspirator.- Computer-interactive stereotaxic tumour excision.- Intraoperative ultrasonography.- Results of surgery.- The case for reoperation for gliomas.- Conclusion.- References.- 12 Radiotherapy for Malignant Brain Tumours.- Biological basis of radiotherapy.- Radiation tolerance of the central nervous system.- Spinal cord tolerance.- Brain tolerance.- Radiotherapy technique.- New radiotherapy techniques.- Radiotherapy in specific tumours.- High-grade astrocytomas.- New approaches.- Low-grade astrocytomas.- Oligodendroglioma.- Ependymoma.- Medulloblastoma.- Pineal tumours.- Primary cerebral lymphoma.- Radiotherapy in other tumours: optic nerve glioma; meningioma; craniopharyngioma.- Brain metastases.- Conclusion.- References.- 13 Chemotherapy of Malignant Brain Tumour.- Summary.- Curative concepts.- Evaluation of therapy.- Special features of chemotherapy of malignant brain tumours.- Space limitation.- Absence of lymph drainage.- Blood-brain barrier.- Neurotoxicity.- Topographical considerations and tumour vascularization.- Postoperative radiological appearances.- Specific treatment.- Symptomatic therapy.- Mode of application.- Systemic administration: intravenous; oral.- Local application: intra-arterial; intratumoral.- Modifications of the blood-brain barrier.- Administration into the cerebrospinal fluid.- Timing of chemotherapy.- Clinical classification of malignant CNS neoplasia.- Proliferation.- Chemotherapy of specific tumour types.- Malignant intrinsic brain tumours.- Anaplastic gliomas and glioblastomas: overview of results of intravenous therapy.- Malignant mesenchymal neoplasms (sarcomas).- Lymphomas and leukaemias.- Brain metastases.- Carcinomatous meningitis: management.- Conclusion.- Appendix I: Some abbreviations and acronyms.- References.- 14 Immunotherapy of Brain Tumours.- Brain tumour immunology: surface antigens on brain tumour; humoral immune response; cell-mediated immune response; modulation of the host immune response by gliomas.- Immunotherapy.- Monoclonal antibodies.- Biological response modifiers: interferons; interleukin-2; tumour necrosis factor; OK-432 and PS-K.- Adoptive cellular therapy.- Conclusion.- References.