In stogeneticheskoy classification upon two criteria histological nature and degree of maturity of the tumor cells. As for the classification of the USSR-nyatoy Smirnova identified 9 groups of tumors of the central nervous system: neuroectodermal, shell disease, mixed (containing cells characteristic of the first two groups), pituitary, geterogopicheskie (epidermoitsy, teratoid), system (neurofibromatosis Reklingauzena, vascular tumors) , metastatic and originating from the walls of the bone sheath (spine, skull).The vast majority of tumors (80%) is included in the first two groups. Of these, the most frequent (62%) tumors of neuroectodermal origin, combining 10 types:
a) medulloblastoma, a malignant tumor predominantly of childhood, most often localizes in the cerebellum, can metastasize to the fluid path, accounting for 7% of all tumors of the central nervous system;
b) spongioblastoma multiforme, malignant neoplasm, occurs more frequently in old age, is localized mainly in the cerebral hemispheres of the brain, constitutes 13,4% of all tumors;
c) polar spondiloma - less malignant than spongioblastoma multiforme; occurs in adults and children, are found in the horny body and the brain stem, is 2.47% of all tumors;
g), benign astrocytoma, the most frequent tumor (20.2%) occurs at any age, in any part of the brain and spinal cord;
e) oligodendrogliomas, benign tumor, arises in middle age, often localized in the cerebral hemispheres, observed in 3,95% of cases;
e) ependymoma - a benign tumor of the walls of the ventricles (usually the IV ventricle) and the central canal of the brain drain (3%);
g) pinealoma-tumor growing from the pineal gland, is more common in men of middle age, is a rare (1,53%);
r)-neurinoma grows out of nerves, including cranial nerves often grows from VIII, less of the III and V nerves, is 7.33%;
s) horioidpapilloma-benign tumor of young patients, localized within the cerebral ventricles, is rare (1,34%);
k) ganglioma-most rare of neuroectodermal tumor, Olay (0,4%) more common in childhood and adolescence in a transparent partition.
Tumors of the second main group - meningeal vascular tissue derived from mesoderm and constitute 19.3% of all tumors. Most in this group are found arachnoiditis-endoteliomy (meningioma) - benign tumors of the shells, which are often observed in adults. Two thirds of tumors in this group are located on convexital surface, a third-under. Occurs in 12% of cases. Much less frequently detected angioretikulomy, observed men in 2 times more frequently than women. The most frequent localization - the cerebellum.
Even rarer are registered primary melatoblastomy (from pigmented cells of pial membranes), vascular tumors (Angiomas), etc. Among the metastatic tumors observed in honey-noma, sarcoma, hypernephroma, and most cancers. Metastasis latter mainly comes from the lung, breast, rarely from the thyroid and prostate glands.
The clinical picture of a brain tumor is composed of two groups of symptoms: of brain (common) and focal (local). The most frequent symptom of cerebral, headache (85-90% of all cases). The mechanism of its occurrence is associated with stimulation of the receptors of the meninges, stretching the walls of the ventricles, compression of the trunk of large cerebral vessels. Pain deep, it breaks, bursting head. At the beginning of the disease have been frequently reported episodes of pain. Later, the headache is of a permanent nature, the intensity of its continued progress. Characterized by increasing pain at night or vpod morning, as well as on exertion, coughing, defecation, changing the usual situation for the patient's head. In addition to bottled headaches resulting from intracranial hypertension and more often in the later stages of disease, distinguished local and headaches. They are based on stimulation of the dura mater, innervated sensitive cranial nerves (trigeminal, vagus, tongue-pharyngeal), intracerebral and meningeal blood vessels, the walls of the large veins of the brain, changes in the bones of the skull. Local pain are boring, throbbing or tugging character. Identifying them is important, because they occur in different stages of the disease and have a definite value for the topical diagnosis. Headaches with a brain tumor can be objectified by percussion and palpation of the skull and facial skeleton (especially if the surface location of the tumor), the change in head position, increased intracranial pressure (straining, coughing, and compression of the neck veins. Bouncing on the ground) in these samples, the parent pain gets worse. More than half of the cases with brain tumors observed vomiting. It is characterized by the appearance of ease, lack of connection with eating, eructation, nausea, abdominal pain. Often it is accompanied by headache, appearing at a height of it. Characteristic and vomiting in the morning, voznikatoschaya depending on the change in head position. In most cases, vomiting occurs when intracranial hypertension due to stimulation of the vomiting center, located at the bottom of the IV ventricle, elongation of the latter. When tumors of the IV ventricle, the medulla oblongata, cerebellar vermis, cerebellar hemisphere, less often, vomiting, focal and early symptom. The third symptom, constituting the above-described triad, characteristic of brain tumors - stagnation nipples optic nerves (see Ophthalmic examination). They occur in 70-83% of patients with brain tumors, as a result of increased intracranial pressure. As a rule, stagnant bilateral nipples. Usually they develop in subtentorial tumors and less frequently in supratentornalnyh. Dizziness is found in half of patients with brain tumors and may be a cerebral symptom, resulting from stagnation in the maze, and focal - the defeat of the vestibular stem centers, temporal or frontal lobe of the cerebral hemispheres. Vertigo (sensation of rotation of the surrounding objects or their bodies) is often accompanied by nausea, loss of balance, vascular events. Mental disorders occur in 60-90% of cases. They are also manifestations of brain disease and is mainly due to increased intracranial pressure, causing varying degrees of disorders of consciousness (stupor, coma), as well as such features as aspontaneity, emotional disturbances, memory disturbances, etc.
Among the symptoms of brain and usually include general epileptic seizures. They are based on stimulation of brain structures by the tumor, and essentially only limited seizures are a local manifestation, but also common, which often occur when the tumor is localized in the cerebral hemispheres, especially in the temporal lobe. Epileptic seizures, a very rare symptom in posterior fossa tumors. Among the frequent general symptoms can include before and bradycardia). However, stable bradycardia can be noted only 10% of patients: it is more typical for brain abscess. Increased intracranial pressure appears to kraniogramme as thinning of flat bones, joints differences (most often in children), the availability of digital impressions, changes in bone structure and (forms of the Turkish saddle. From the cerebrospinal fluid are the following characteristic changes: Cerebrospinal fluid pressure rises to 250-400 mm (normal 100-200 mm of water. c.).. In some cases, the fluid does not flow drops and the jet. A typical protein-cell dissociation: the protein content ranged from 0.5 to 2%. In some cases, there is a higher protein content and cell elements. It should be emphasized that the general-brain symptoms are usually more intense when subtentorial tumors than in the supratentorial. Tumors located in the posterior cranial fossa faster entail increased pressure inside the skull, due to the limited amount of this area and a lighter appearance of a violation communication between the ventricular system. communication between the ventricular system and subarachnoid.
Supratentorielnye tumors constitute about 70% of all brain tumors.
Tumors of the frontal lobe. The most common glioma multiswitch tiformnye spongioblastoma deep in proportion, in astrocytomas of surface divisions) and arahnoidendoteliomy, located in the parasagittal and olfactory pit at the base of the brain. Early symptoms include local unilateral headaches, seizures, often starting with the violent turn of the head and eyes in a healthy direction, mental disorders as a violation of orientation in the environment, unmotivated behavior, inappropriate jocularity, foolishness, adynamia, apatiko-abulicheskimi syndrome. An early manifestation of the disease may be paresis of the facial nerve (central), grasping reflex on the opposite side of the tumor. Characteristic in the later stages of a syndrome Fester Kennedy - primary optic atrophy on the side of the tumor and the stagnation in the other eye. Often there are exophthalmos on the side of the tumor, the phenomenon of ataxia (frontal), differing from the cerebellar lack of muscular hypotonia, meningeal symptoms.
Tumors of the parietal lobe. Most often this gliomas (astrocytomas and multiforme spongioblastoma) and arahnoidendoteliomy. Typical focal symptoms: a violation sensitivity (mainly distinguished complex shapes and deep muscle sense), in-fracture of the body schema, astereognosis. When left-sided localization-apraxia (focus in depth), that the ability of reading, writing, numeracy, the phenomenon of amnestic aphasia. Movement disorders observed in the subcortical tumor.
Tumors are sensitive-motor area. A number of authors, they were isolated from tumors of the parietal and frontal lobes. Characteristic phenomena of irritation and loss of motion and sensitivity:
The first manifested Jackson convulsive or sensitive seizures, which are typically spread on the body in accordance with the location of cortical centers. Most seizures are limited to one half of the body, rarely were generalized and accompanied by loss of consciousness. The loss reflected monoparezami with cortical and hemiparesis with deep pockets. It is not uncommon logaphasia (with left-sided foci). In parasagittal localization arise pelvic disorders (urinary incontinence and fecal incontinence). Arahnoidendoteliomy Sylvian fissure, in addition to these symptoms occur more acoustic-vestibular disorders, tumors of the temporal region. Gliomas are found in 2 times more likely than arahnoidendoteliomy. Focal symptoms characteristic of both sides, are the olfactory and taste disorders, visual and auditory hallucinations, general seizures, hemianopsia with foci in the posterior portions of the share, disorders of the oculomotor and trigeminal nerves. When left-sided localization (in right-handed) - sensory aphasia. To this location is typical early appearance of brain symptoms.
Tumors of the occipital lobe. Are relatively rare, is dominated gliomas, in second place arahnoidendoteliomy. The main focal symptom, visual disturbances (visual hallucinations, hemianopsia, impairment of chromatic sensitivity.
With the growth of tumors appear gnostic disorders, especially alexia. Early cerebral symptoms occur.
When arahnoidendoteliomah cerebellar gallop noted tentorial syndrome Burdenko-Cramer, ie, pain, radiating to the eyeball and the orbit, lacrimation. Tumors of the corpus callosum. Most of the polarity or multiforme spongioblastoma astropitomy. Characteristic psychiatric disorders (confusion, dementia, gross violations of memory), pseudobulbar phenomenon. Left-hand apraxia, which attached great importance to earlier, is found not in all cases.
Tumors of the lateral ventricles. In the anterior regions are more common than ependymomas in the back - and horioidpapillomy arahnoidendo-teliomy. In the foreground of cerebral symptoms caused by the internal closed hydrocephalus. Against this background, may be a violation of statics and gait, tonic convulsions, respiratory failure, symptoms of autonomic centers, located on the bottom of the III ventricle, motor disturbances and disorders of sensitivity. In a number of observations indicated forced position of the head.
Tumors of pituitary-hypothalamic region. The most characteristic sight disorders (related to the pressure of the tumor to the chiasma) and endrokrinno-vegetative disorders. Most pituitary tumors are observed: adenoma, located in the anterior lobe, craniopharyngiomas, in intermediate-grade gliomas in the rear. Among adenomas first place in the frequency occupy hromofobnye, giving a picture of hypopituitarism (violation of sexual function, obesity, trophic disorders, growth retardation). In second place are eosinophilic tumor manifesting acromegaly. Less common basophil adenoma causing Cushing's syndrome-Itsenko. For the diagnosis of critical values of chenie has an X-ray of the sella turcica, which are determined by an increase in its size, expanding and deepening the entrance-ing bottom. With small size of the tumor, these changes may be absent. As its growth and spread beyond the diaphragm of the sella turcica appear ocular symptoms associated with the pressure at the chiasmata (bitemporal loss of visual fields and simple atrophy of the optic nerves). There are certain manifestations of diencephalic syndrome (see) in connection with invasion of the tumor in the hypothalamus. Local symptoms are accompanied by cerebral symptoms. Close to that described the picture and give craniopharyngioma. Depending on the predominant location (inside seating or above it) are dominated by the pituitary or gipotalamozritelnye disorders. Cranyopharyngiomas feature is often kistoobrazovanie followed the deposition of lime in their walls, which allows them to determine radiologically. Primary tumors of the hypothalamic region (gliomas) are characterized by cerebral, central and dienpialnoy pathology. Arahnoidendoteliomy tubercle of the sella turcica primarily manifested reduced vision, loss of shares of (temporal). In the future, identifies basal meningeal, hypothalamic and endocrine-hypertensive syndromes, tumors subtentorial. These tumors account for 30% of brain tumors in adults. For the whole group is characterized by an early manifestation of brain symptoms.
Tumors of the cerebellum. Most often this astrocytoma, medulloblastoma, and less angioretikulomy. The earliest symptom is a headache accompanied by vomiting. Key focal symptoms: ataxia, muscular hypo-.toniya, nystagmus. With the growth of tumors of the worm is observed bilateral symptoms of static-priority coordination, the early appearance of pathological symptoms of the IV ventricle (intracranial hypertension, seizures, vomiting brunsopodobnye with a change in head position, respiratory and cardiovascular activity). Hemispheric tumors often unilateral. In the later period, they cause changes in the intracranial pressure, characteristic of static and dynamic koordinatornye disorders. When the process in the upper hemisphere coarser suffers hand injury in the lower divisions leg.
Tumors Mosto-cerebellar angle. The most common neurinomas of the auditory nerve, then arahnoidendoteliomy and cholesteatoma. Neurinoma or affect both branches, or appear at first pathology only from the vestibular branch, expressed dizziness. One of the first symptoms, hearing loss, accompanied by noise. Sooner is involved in the process of root of the trigeminal nerve (pain, paresthesia, reduced corneal reflex) and vrisbergov nerve (taste disturbances). In half of the observed part of the facial nerve (expressed as a defeat is rare), as well as abducent. With the growth of the tumor revealed cerebellar, stem and cerebral symptoms. Bilateral neurinomas VIII nerve occur in neurofibromatosis Reklingauzena (see).
