Intracranial Mass Lesions

Abstract

Intracranial masses may be life-threatening lesions that are refractory to even the most aggressive treatment or benign and require only occasional observation. Metastatic tumors are the most common intracranial tumors in adults, and usually portend a poor prognosis. Glial tumors may be divided into glioblastoma multiforme and other high-grade tumors which progress despite multimodal treatment and low-grade tumors which may be relatively benign. Meningiomas are most often benign tumors that come to clinical attention by causing mass effect or are noticed incidentally on a neuroimaging study ordered for an unrelated reason. Primary central nervous system lymphoma (PCNSL) may occur in both immunocompromised and immunocompetent patients. Important non-neoplastic supratentorial mass lesions include arteriovenous malformations, abscesses, and tumefactive multiple sclerosis. Sellar region tumors may produce headaches, visual field defects, and extraocular movement disorders. The most common lesions in the sellar region are adenomas, craniopharyngiomas, and meningiomas. Cerebellopontine angle lesions such as vestibular schwannomas may come to clinical attention by producing hearing loss or imbalance. Masses that occur with greater frequency in immunocompromised patients, particularly those with HIV include PCNSL and toxoplasmosis. Patients from the tropics and the developing world are at risk for several infections that may produce cerebral masses, most importantly neurocysticercosis and tuberculosis.