There are many methods to classify gliomas, and clinical workers often use Kernohan classification, which is relatively simple. Among all types of gliomas, astrocytoma is the most, followed by glioblastoma, medulloblastoma, ependymoma, oligodendroglioma, pineoma, mixed glioma, choroid plexus papilloma, unclassified glioma and neuronal tumor. The prone sites of gliomas are different. For example, astrocytoma is mainly found in adult cerebral hemisphere and cerebellum of children. Glioblastoma almost always occurs in the cerebral hemisphere; Medulloblastoma occurs in the vermis of cerebellum; Ependymomas are more common in the fourth ventricle; Most oligodendrogliomas occur in the cerebral hemisphere.
Gliomas are more common in men, especially glioblastoma multiforme and medulloblastoma, and men are obviously more than women. All kinds of glioblastoma are more common in middle-aged people, ependymoma is more common in children and young people, and medulloblastoma is almost common in children. The location of glioma is also related to age. For example, astrocytoma and glioblastoma are more common in adults, while cerebellar gliomas (astrocytoma, medulloblastoma and ependymoma) are more common in children.
Most gliomas develop slowly, and the time from symptoms to treatment is usually weeks to months, and a few can reach years. High degree of malignancy, short history of tumors in posterior cranial fossa, and long history of tumors in benign or resting areas. If the tumor is bleeding or cystic, the symptoms will suddenly worsen, and even a process similar to cerebrovascular disease will occur. The clinical symptoms of glioma can be divided into two aspects: first, the symptoms of increased intracranial pressure, such as headache, vomiting, decreased vision, diplopia and mental symptoms; The other is the focal symptoms caused by tumor compression, infiltration and destruction of brain tissue, which can be manifested as stimulating symptoms such as localized epilepsy in the early stage and neurological deficit symptoms such as paralysis in the later stage.
The diagnosis of glioma was analyzed according to its biological characteristics, age, sex, prone location and clinical progress. On the basis of medical history and signs, electrophysiology, ultrasound, radionuclide, radiology, nuclear magnetic resonance vibration and other auxiliary examinations were used. The accuracy of location is almost 65,438+0,000%, and the accuracy of qualitative diagnosis can reach over 90%. The treatment of glioma is mainly surgical treatment. Because the tumor is invasive and the boundary with brain tissue is unclear, it is difficult to completely remove it. Postoperative radiotherapy, chemotherapy and immunotherapy are extremely necessary. The principle of surgical treatment is to remove the tumor as much as possible on the premise of preserving neurological function. If the early tumor is small and located in the appropriate part, it can be completely removed. Tumors located in the frontal or temporal lobes can be removed. When the frontal or temporal lobe tumor cannot be completely removed, the frontal pole or temporal pole can be removed at the same time for internal decompression. If the tumor is located in the motor and speech areas without obvious hemiplegia and aphasia, attention should be paid to preserving nerve function and properly removing the tumor to avoid serious sequelae. Ventricular tumors should be cut into the brain tissue from the non-functional area and enter the ventricle, and the tumor should be removed as much as possible to relieve brain obstruction. Gliomas located in thalamus and brain stem, except small nodular or cystic tumors, are generally treated by shunt and radiotherapy after relieving intracranial hypertension. Radiotherapy should be given as soon as possible after the general condition is restored after operation.
Chemotherapy for glioma tends to be combined with drugs. According to the cell dynamics and the specificity of drugs to cell cycle, several drugs are used to improve the curative effect. Such as nitrosourea combined with VCR and PCB, or combined with VM26, ADM, MTX, BLM, etc. In order to increase local drug concentration and reduce systemic toxicity, special routes of administration can also be adopted, such as local injection of ADM and MTX through Ommaya repository. Anti-cancer drugs are injected from arteries supplying tumor blood through selective catheters.
Immunotherapy for glioma, including active immunization with tumor vaccine, intratympanic injection of immune ribonucleic acid and application of immunomodulators such as levamisole, PSK and PSP, is also applied in clinic, which can reduce the reaction of radiotherapy and chemotherapy and enhance immunity.
At present, "bufotoxin" is the most ideal drug with gene expression function for the treatment of glioma angiogenesis.
Diagnosis of glioma
According to its age, sex, location and clinical process, the diagnosis was made and its pathological type was estimated. In addition to medical history and neurological examination, some auxiliary examinations are needed to help diagnose, locate and characterize.
(1) Cerebrospinal fluid examination: Most of the puncture pressure of lumbar vertebrae increased. Some tumors, such as those located on the surface of the brain or in the ventricle, can increase the amount of protein in cerebrospinal fluid and the number of white blood cells, and some tumor cells can be found. However, if the intracranial pressure is significantly increased, lumbar puncture may promote cerebral hernia. Therefore, it is generally only done when necessary, such as when it needs to be differentiated from inflammation or bleeding. If the pressure rises obviously, be careful and don't put too much cerebrospinal fluid. Mannitol drip was given after operation and observed.
(2) Ultrasonic examination: It can help to locate the lateral position and observe whether there is hydrocephalus. The baby can be scanned by B-ultrasound through the front fontanel, and tumor images and other lesions can be displayed.
(3) EEG examination: On the one hand, the EEG changes of glioma are limited to the brain wave changes at the tumor site. On the other hand, the frequency and amplitude of the general distribution change. These are influenced by tumor size, invasiveness, degree of brain edema and increased intracranial pressure. Shallow tumors are prone to localized abnormalities, while deep tumors have few localized changes. Benign astrocytoma, oligodendroglioma, etc. The main manifestations are localized δ waves, and some epileptic waves such as spikes or sharp waves can be seen. Large glioblastoma multiforme can show a wide range of δ waves, sometimes only localized.
(4) Radioisotope scanning (γ-ray electroencephalogram): A tumor with rapid growth and abundant blood supply has high permeability of blood-brain barrier and high isotope absorption rate. For example, glioblastoma multiforme shows dense isotope images, and there may be low-density areas of necrosis and cyst formation in the middle, so it should be differentiated from metastatic tumors according to its morphology and multiplicity. The concentration of benign gliomas, such as astrocytomas, is low, often slightly higher than the surrounding brain tissues, and the images are not clear enough, and some of them may be negative findings.
(5) Radiological examination: including skull plain film, ventriculography and computed tomography. Cranial plain film can show intracranial hypertension, tumor calcification and pineal calcification displacement. Ventricular angiography can show cerebral vascular displacement and tumor blood vessels. These abnormal changes are different in different parts and types of tumors, which can help to locate and sometimes even be qualitative. Especially CT scan has the greatest diagnostic value. The accuracy of localization and qualitative diagnosis is close to 100% and 90% respectively. It can display the location, scope, shape, brain tissue reaction and ventricular compression and displacement of the tumor. However, comprehensive consideration is still needed to make a definite diagnosis.
(6) Magnetic resonance imaging: Compared with CT, the diagnosis of brain tumors is more accurate, the images are clearer, and tiny tumors that cannot be displayed by CT can be found.
Positron emission tomography can obtain images similar to CT, observe the growth and metabolism of tumors, and distinguish between benign and malignant tumors.
Clinical manifestations of glioma
The course of glioma varies with its pathological type and location, and the time from symptoms to medical treatment is usually several weeks to months, and a few can reach years. The history of malignant tumor and posterior cranial fossa tumor is short, while the history of benign tumor or tumor located in so-called quiet zone is long. If the tumor has bleeding or cyst formation, the development process of symptoms can be accelerated, and some can even be similar to the development process of cerebrovascular diseases.
There are two main manifestations of symptoms. First, common symptoms such as increased intracranial pressure, such as headache, vomiting, decreased vision, diplopia, seizures and other mental symptoms. The other is the local symptoms caused by tumor compression, infiltration and destruction of brain tissue, which leads to the loss of nerve function.
Headaches are mostly caused by increased intracranial pressure. With the growth of tumor, intracranial pressure gradually increases, which oppresses and involves intracranial pain-sensitive structures such as blood vessels, dura mater and some cranial nerves, leading to headache. Most of them are jumping pain and swelling pain, mostly located in frontotemporal or occipital, superficial tumors on one side of cerebral hemisphere. Headache can be mainly located in the affected side, and headache begins to be intermittent, mostly in the early morning. With the development of tumor, headache is getting worse and the duration is prolonged.
Vomiting is caused by stimulating the vomiting center or vagus nerve in the medulla oblongata, but it is first ejected without nausea. Children's headache is not obvious because of the separation of cranial suture, and vomiting is more prominent because of common tumors in posterior cranial fossa.
The increase of intracranial pressure can produce papilla edema, and cause secondary atrophy of optic nerve and decreased vision for a long time. When tumors compress the optic nerve, primary optic atrophy will occur, which will also lead to decreased vision. Abduction nerve is easily squeezed and involved, which often leads to paralysis and diplopia.
Some tumor patients have epileptic symptoms, which can be early symptoms. Epilepsy begins in adulthood, which usually has symptoms, mostly caused by brain tumors. If the drug is difficult to control or the nature of the attack changes, brain tumors should be considered. Patients with tumors near the cortex are prone to epilepsy, while patients with tumors in the deep part rarely have epilepsy. Localized epilepsy has localization significance.
Some tumors, especially those located in the frontal lobe, can gradually appear mental symptoms, such as personality change, apathy, decreased speech and activities, inattention, memory loss, indifference to things, impurity and so on.
Local symptoms gradually worsen according to the location of the tumor. Especially malignant glioma, which grows rapidly, infiltrates and destroys brain tissue, peripheral brain edema is obvious, local symptoms are obvious and develops rapidly. Intracerebroventricular tumors or tumors located in quiet areas may have no local symptoms in the early stage. However, tumors in important functional parts such as brain stem have local symptoms in the early stage, and intracranial hypertension takes a long time to appear. Some slow-developing tumors often have symptoms of increased intracranial pressure due to compensation until the late stage.
Pathogenesis of glioma
Because the tumor grows gradually, it forms intracranial space-occupying lesions, often accompanied by peripheral brain edema. When the compensation limit is exceeded, the intracranial pressure increases. When the tumor blocks cerebrospinal fluid circulation or compresses veins, resulting in venous reflux disorder, intracranial pressure is higher. If bleeding, necrosis and cyst formation occur in the tumor, the process can be accelerated. When increased intracranial pressure reaches the critical point, the intracranial volume will continue to increase slightly, and the intracranial pressure will increase rapidly. If the intracranial pressure is monitored, when the pressure reaches 6.67 ~ 13.3 kPa Hg, plateau waves will appear and appear repeatedly for a long time, which is the clinical sign. When intracranial pressure is equal to arterial pressure, cerebral vascular paralysis, cerebral blood flow stops and blood pressure drops, and patients will soon die.
When the tumor grows, the local intracranial pressure is the highest, and a pressure gradient is generated between intracranial chambers, which causes brain displacement and gradually aggravates the formation of cerebral hernia. Tumors in the supratentorial hemisphere can produce subfascular hernia, and the cingulate gyrus moves across the midline, which can cause wedge-shaped necrosis. The peripheral angular artery can also be displaced due to compression, and in severe cases, cerebral infarction in the blood supply area can occur. More importantly, tentorial notch hernia, that is, the medial sulcus gyrus of temporal lobe is displaced to the posterior cranial fossa through tentorial notch. The ipsilateral oculomotor nerve was paralyzed by compression, the pupil dilated and the light response disappeared. The cerebral peduncle of midbrain is compressed to produce contralateral hemiplegia. Sometimes the contralateral cerebral peduncle presses the edge of the tentorium cerebelli or the bone tip, resulting in ipsilateral hemiplegia. Posterior choroidal artery and posterior cerebral artery can also be compressed to cause ischemic necrosis. Finally, the compression of the brain stem can produce downward axial displacement, leading to infarction and bleeding of the midbrain and superior pontine. The patient is in a coma, his blood pressure is rising, his pulse is slow, his breathing is deep and irregular, and he may have brain rigidity. Finally, breathing stops, blood pressure drops, cardiac arrest, and death. Tumors in the infratentorial posterior cranial fossa can produce foramen magnum hernia, the cerebellar tonsil moves down and herniates out of the foramen magnum. In severe cases, the ventral medulla oblongata compresses the anterior edge of foramen magnum. Supratentorial tumors may also be accompanied by foramen magnum hernia. Causes medullary ischemia, coma, high blood pressure, slow and strong pulse, and deep and unplanned breathing. Then breathing stopped, blood pressure dropped, pulse rate was weak, and eventually he died.
Epidemiology of glioma
Glioma is the most common intracranial tumor. Astrocytoma is the most common glioma, followed by glioblastoma multiforme and ependymoma. According to the statistics of affiliated hospitals of xuanwu hospital and Tianjin Medical College, among 2573 cases of glioma, 39.65438 0%, 25.8% and 65438 08.2% respectively.
Sex is more common in men, especially glioblastoma multiforme and medulloblastoma. Most of them are between 20 and 50 years old, and the peak is 30 to 40 years old, which is also common in children around 10 years old, which is another small peak.
Each type of glioma has its own age, such as astrocytoma, glioblastoma multiforme, ependymoma and medulloblastoma. The prone sites of various types of gliomas are also different. For example, astrocytomas mostly occur in adult cerebral hemisphere, while children mostly occur in cerebellum. Glioblastoma multiforme almost always occurs in the cerebral hemisphere. Ependymomas are more common in the fourth ventricle; Most oligodendrogliomas occur in the cerebral hemisphere, and almost all medulloblastomas occur in the vermis of cerebellum.
The following is for reference.
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about the early detection of brain tumors.
Moderator: Is a headache just a brain tumor?
Zhao Jizong: Headache is a symptom that everyone has, and most of it is not caused by brain tumor. There are many causes of headache, such as neurasthenia, overwork and poor sleep. There are also paroxysmal migraine, eye ametropia, myopia, sinusitis and so on. However, all of them can be relieved after symptomatic medication, and headaches caused by brain tumors are less common. Headache caused by brain tumor is a severe and persistent headache. When you get up in the morning, you will feel very painful. Taking painkillers can only relieve it for a while. In addition, headaches can be accompanied by vomiting.
Moderator: Are there many people suffering from brain tumors in China?
Zhao Yuanli: Not many people suffer from brain tumors. The incidence of brain tumors is 1 10,000 people 1 person per year. There are more than ten kinds of brain tumors: congenital, acquired, benign and malignant.
Moderator: What are the hazards after suffering from brain tumor?
Zhao Jizong: Cranial cavity includes brain, blood vessels, hydrocephalus and nerves. Brain tumors also grow in the skull, so they will squeeze normal brain tissue and are not easy to find. The brain is like the headquarters of the human body. Once it goes wrong, all organs in the body will be abnormal.
Zhao Yuanli: After increased intracranial pressure, there will be headaches and vomiting. Vomiting of brain tumor is jet. After vomiting, headache symptoms will be relieved. The longer the brain tumor, the more serious the symptoms will be. Sometimes there will be fundus edema, blurred vision and decreased vision. It may also lead to neurological disorders and dysfunction of the brain or cerebellum.
Moderator: Can brain tumors be inherited?
Zhao Jizong: In recent years, it has been found that some tumors are hereditary but benign, such as cavernous hemangioma, angioreticuloma and neurofibromatosis.
Moderator: What other symptoms can brain tumors cause?
Zhao Jizong: There are 12 pairs of cranial nerves in the brain, which are responsible for the functions of the five senses of the head. After the appearance of brain tumor, it will affect the function of brain nerve and lead to dysfunction of five senses. If the brain tumor grows in the cerebellum, the patient will walk unsteadily. If a brain tumor grows in the brain, it will affect movement, mood and language.
Moderator: There is a woman, menopause, lactation. The doctor said she had a brain tumor. Why?
Zhao Jizong: Brain tumors are also related to endocrine. The endocrine center of the skull base is called pituitary gland. Once there is a problem, it will cause endocrine abnormalities. Such patients often go to obstetrics and gynecology for examination first, and then cause other symptoms when the tumor grows up. It was only after examination that it was found that the brain tumor was advanced; Congenital craniopharyngioma in adolescents will affect children's development, resulting in short stature and thirst. After the child gets this disease, he drinks a lot of water, and he can drink tens of thousands of milliliters of water in 24 hours, so he urinates a lot, which will also affect his vision in the later stage. At this time, they should go to a special hospital to check whether there is a brain tumor.
Moderator: Ms. Zhou's son in Beijing is 2 1 year old. At the age of 65,438+08, he suddenly went crazy. After that, every year 1-2 episodes. Now he is taking phenytoin sodium without any symptoms. What tests need to be done? Is it a brain tumor?
Zhao Jizong:/kloc-Teenagers over 0/5 years old suddenly go crazy, which is usually a brain tumor, but it may also be caused by vascular malformation, parasites and other reasons. It is suggested to go to a specialized hospital for magnetic resonance imaging (MRI) examination, and children under 15 suddenly become insane, which may be primary epilepsy. At present, the cause of the disease is not very clear.
Moderator: Ms. Lu from Zhejiang often has headache and vomiting, but she will be fine after a sleep. Does she have a brain tumor?
Zhao Yuanli: Headache can be caused by many reasons. If the headache is accompanied by jet vomiting, it is recommended to go to a specialized hospital for CT or magnetic resonance imaging.
Moderator: Mr. Zhu's daughter in Henan is 3 years old. There is a germ cell tumor in her brain, 2 cm in size. Symptoms are precocious puberty and breast development. How to treat it?
Zhao Jizong: I used to need surgery, but now I can use radiotherapy. Because I am very sensitive to radiotherapy drugs, germinomas will disappear in less than a course of treatment, and the effect is very good.
Moderator: How to find brain tumors early?
Zhao Yuanli: If you have the above symptoms, you should go to the hospital neurology department for detailed examination, such as CT and magnetic resonance imaging.