This chapter begins with a discussion of common major clinical features and mechanisms of damage produced by brain tumors. Brain tumors are a collection of neoplasms of differing cell types, biology, prognosis, and treatment arising as a primary tumor or metastasis. Primary brain tumors in adults develop mainly above the tentorium while primary tumors develop in infants and children mainly in the posterior fossa. Most CNS tumors are of glial origin. Brain tumors produce signs and symptoms by three mechanisms: tumor location, tumor mass producing signs, and symptoms as it expands in a closed intracranial space, and finally the mass creating sufficient increased intracranial pressure to shift intracranial structures resulting in downward brain herniation. Brain tumors often cause cerebral edema with excess fluid either locally or diffusely in the brain. The cerebral edema can be vasogenic, cytotoxic, or interstitial. The chapter then discusses malignant glioma, meningioma, pituitary adenoma, and cerebral metastasis with attention to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.
KeywordsGlioma Meningioma Pituitary adenoma Cerebral metastasis Uncal herniation Tonsillar herniation Cerebral edema Vasogenic edema
- Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med. 2008;359:492–507. (Excellent overall review).Google Scholar
- Fishman RA. Brain edema. N Engl J Med. 1975;293:706–11. (Classic review of types of cerebral edema and their treatments).Google Scholar
- White IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004;363:1535–43. (Reviews of clinical, neuroimaging, and treatment of meningiomas).Google Scholar
- Lleva RR, Inzucchi SE. Diagnosis and management of pituitary adenomas. Curr Opin Oncol. 2010;23:53–60. (Covers epidemiology, pathogenesis, presentation, neuroimaging, and. management of the common pituitary tumors).Google Scholar
- Khasraw M, Posner JB. Neurologic complications of systemic cancer. Lancet Neurol. 2010;9:1214–27. (Good brief review of brain metastases and the treatment options).Google Scholar
- DeAngeles LM, Posner JB. Neurologic complications of cancer. 2nd Ed. New York: Oxford University Press; 2009. (Excellent comprehensive review of all types of CNS cancer complications including metastases to brain and leptomeninges, CNS infections, paraneoplastic syndromes and side effects of chemotherapy and radiation).Google Scholar