Paediatric TumoursDr Malith Kumarasinghe

MBBS (Colombo)

Pediatric Neurosurgical Neuropathology

Brain tumors are second only to leukemias in children

Brain tumors are the most common solid organ tumor in children

70 of pediatric brain tumors are in the posterior fossandash Pilocytic astrocytomandash Medulloblastomandash Ependymoma

CNS tumors pediatric vs adult Adults 70 of tumors are

supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma

raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)

Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar

astrocytoma)ndash medulloblastoma

Brain tumors intro Intracranial neoplasms

ndash Primaryndash Secondary

raquo Metastaticraquo Local invasion

Tumors of the spinal cord

Primary brain tumors intro Primary brain tumors are rare

ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors

Most common typesndash Astrocytomas

raquo Grades I-IVndash Medulloblastomas

raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Pediatric Neurosurgical Neuropathology

Brain tumors are second only to leukemias in children

Brain tumors are the most common solid organ tumor in children

70 of pediatric brain tumors are in the posterior fossandash Pilocytic astrocytomandash Medulloblastomandash Ependymoma

CNS tumors pediatric vs adult Adults 70 of tumors are

supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma

raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)

Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar

astrocytoma)ndash medulloblastoma

Brain tumors intro Intracranial neoplasms

ndash Primaryndash Secondary

raquo Metastaticraquo Local invasion

Tumors of the spinal cord

Primary brain tumors intro Primary brain tumors are rare

ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors

Most common typesndash Astrocytomas

raquo Grades I-IVndash Medulloblastomas

raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

CNS tumors pediatric vs adult Adults 70 of tumors are

supratentorialndash meningiomandash pituitary adenomandash High grade astrocytoma

raquo Anaplastic astrocytoma (grade III)raquo Glioblastoma multiforme (grade IV astrocytoma)

Pediatric 70 in posterior fossandash pilocytic astrocytoma (cerebellar

astrocytoma)ndash medulloblastoma

Brain tumors intro Intracranial neoplasms

ndash Primaryndash Secondary

raquo Metastaticraquo Local invasion

Tumors of the spinal cord

Primary brain tumors intro Primary brain tumors are rare

ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors

Most common typesndash Astrocytomas

raquo Grades I-IVndash Medulloblastomas

raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Brain tumors intro Intracranial neoplasms

ndash Primaryndash Secondary

raquo Metastaticraquo Local invasion

Tumors of the spinal cord

Primary brain tumors intro Primary brain tumors are rare

ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors

Most common typesndash Astrocytomas

raquo Grades I-IVndash Medulloblastomas

raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Primary brain tumors intro Primary brain tumors are rare

ndash 25 of all cancer deathsndash Second most common type of tumor in childrenndash There are over 100 different brain tumors

Most common typesndash Astrocytomas

raquo Grades I-IVndash Medulloblastomas

raquo primitive neuroectodermal tumor-PNETndash Meningiomasndash Pituitary adenomas

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Clinical presentation Clinical symptoms depend upon

ndash Age location and type of tumor and grade Symptoms may include

ndash Increased intracranial pressure raquo secondary to obstruction of CSF at aqueductraquo hydrocephalus (infants) headache papilledema

vomitingndash seizuresndash focal neurological deficits ndash hormonal changes (pituitary adenoma)ndash visual changes (diplopia field defects)

raquo Pituitary adenoma - pressure on optic chiasm

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

CNS tumors diagnosis Symptoms prompt neuroimaging CT and MRI

ndash intra-axial vs extra-axialndash Location of tumorndash contrast enhancement

raquo typical of high graderaquo also in some low grade ie pilocytic

astrocytomas

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

CNS tumors location Extra-axial

ndash meningiomas Cerebral hemispheres

ndash grade II-III astrocytomas GBM Crossing corpus callosum - GBM optic nerve - pilocytic astrocytoma

(NF-1) Sella - Pituitary adenoma Peri-III ventricle - Pilocytic astrocytoma

GBM

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

CNS tumors location posterior fossa (in children)

ndash pilocytic astrocytomandash medulloblastoma

brainstem (pons) ndash pontine glioma (astrocytoma)

spinal cordndash low-grade astrocytomas (grade I and II)

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Pilocytic astrocytomasndash Most common in childrenndash Grade I astrocytomandash Cerebellum (posterior fossa) optic nerve

raquo Thalamic spinal cord cerebralndash Discrete well circumscribed massndash Often with associated cystic areandash Contrast enhancingndash Histologic appearance

raquo Biphasic piloid cells and microcystic areasraquo Rosenthal fibersraquo no mitoses

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Pilocytic astrocytomas

Tumor of cerebellum often with cyst biphasic Rosenthal fibers piloid cells

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Astrocytoma - high grade Astrocytoma grade II and III are very very rare

in the pediatric population Grade IV - glioblastoma multiforme Diffusely infiltrating glial tumor of cerebral

hemispheres Contrast enhancing tumor Histological appearance

ndash Densely cellular with marked nuclear pleomorphismndash Numerous mitosesndash Endothelial proliferationndash Necrosis with pseudopallisading

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Glioblastoma (grade IV)

Less common in children than adults typical pathology (necrosis with psuedopallisading)

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Pontine glioma

Diffuse expansion of pons usually high grade astrocytoma (III-IV)

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Medulloblastomas posterior fossa in children Histologic appearance

ndash Densely cellular ldquosmall blue cell tumorrdquondash Numerous mitosesndash Apoptotic (karyorrhectic) cellsndash Endothelial proliferationndash Necrosisndash neuronal or glial differentiation

raquo Homer Wright rosettesraquo GFAP positive cells

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Medulloblastoma

Mass arising in roof of fourth ventricle

Homer Wright rosettes

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Ependymoma

Mass arising in floor of fourth ventricle

Perivascular pseudorosettes

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Meningiomas Discrete non-invasive tumor

ndash Extra-axial pushes into brainndash Attached to durandash Hyperostosis or invasion of skull

common Histologic appearance

ndash Fibroblastic or menigothelial cellsndash Meningothelial whorlsndash Psammoma bodies

Rare in children may be intraventricular (lateral ventricles)

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Meningiomas

Extra-axial tumor meningothelial cells whorls and psammoma bodies

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Ganglioglioma

Cerebrum cervicomedullary often with cystic componentIncreased numbers of neurons (some binucleate) and increased

glial cells (usually astrocytic)

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Craniopharyngioma

Heterogeneous cystic mass in suprasellar region Basiloid layer stellate reticulum ldquowetrdquo keratin

often calcified

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Choroid plexus papilloma

Lateral ventricle in children (fourth ventricle in adults)

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Germ cell tumors

Pineal - 99 males most are germinomas Suprasellar - often mixed germ cell tumor

50 female Tertomas are rare

Germinoma Teratoma

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Metastatic tumors The most common ldquobrainrdquo tumor in adults

is metastatic Metastatic tumors are rare in children The most common metastatic tumor in children

is osteosarcoma Local extension of malignant tumors of

vertebral bodies (Ewingrsquos sarcoma) or paravertebral soft tissues (neuroblastoma) are not uncommon

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Other tumors Subependymal giant cell astrocytoma (SEGA)

ndash Intraventricular tumor in Tuberous sclerosis Desmoplastic infantile ganglioglioma (DIG)

ndash Superficial cerebral tumor in infants Dysembryoplastic neuroepithelial tumor (DNET)

ndash Hamartomatous lesion associated with seizures Atypical teratoid rhabdoid tumor (ATR ATRT)

ndash Infants posterior fossa very malignant Eosinophilic granuloma

ndash A type of Langerhans cell histiocytosisndash Single discrete osteolytic lesion in skull

Meningioangiomatosisndash Hamartomatous superficial cerebral lesion associated

with seizures

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Hereditary syndromes Neurofibromatosis type I

ndash Cafeacute-au-lait spotsndash Dermatofibromas multiplendash optic nerve gliomas bilateral ndash plexiform neurofibroma ndash Malignant peripheral nerve sheath

tumor Neurofibromatosis type II

ndash bilateral acoustic neuromandash multiple meningiomasndash ependymomas

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

1048708 Most intraspinal tumors present by compression rather than invasion

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Compression Syndromes

1048708 Rootndash severe sharp shooting pain with weakness or numbness in distribution of root (radicular)

1048708 Bonendash continuous dull pain and tendernessndash may not be relieved by rest

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Compression Syndromes

1048708 Anteriorndash bilateral weakness dissociated sensory loss(loss of pain and temperature retainedposition sense pressure vibration)

1048708 Posteriorndash rare produces paresthesias impairedposterior column function

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Compression Syndromes

1048708 Lateralndash aka Brown Sequardndash contralateral loss of pain and temperature 1-2

segments belowinjuryndash ipsilateral loss of posterior column function and

weaknessndash best prognosis of any spinal cord syndrome

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Compression Syndromes1048708 Central

ndash weakness of UE gt LEndash ldquocape-likerdquo sensorydeficit

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Location

1048708 Extradural (ED)1048708 Intradural

Extramedullary(IDEM)

1048708 Intramedullary (IM)

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Extradural Tumors1048708 55 of spine tumors

1048708 tissues bone epidural fat vessels

1048708 majority are metastatic

1048708 ldquofeatheredrdquoappearance on myelogram

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Extradural Tumors Metastatic

ndash usually cause bone destructionndash include lung lymphoma breast and prostate(last two may be osteoblastic)

Tumors with both ED and ID potentialndash meningiomas (15 are wholly extradural)ndash neurofibromas

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Spine Based Tumors

1048708 Benignndash hemangioma osteoid osteomaosteoblastoma

osteochondroma giant cell tumors eosinophilic granulomas aneurysmal bone cysts

1048708 Malignantndash chordoma osteosarcoma chondrosarcoma

fibrosarcoma Ewingrsquos sarcoma multiple myeloma lymphoma neuroblastoma mets

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Extradural Tumors1048708 Chloromasndash focal infiltrate of leukemic cells1048708 Angiolipomasndash very rare (60 cases in literature)1048708 Spine based tumors

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Intradural Extramedullary1048708 40 of spinal tumors1048708 tissues nerve roots meninges CSF1048708 4 of spinal metastatic lesions1048708 sharp meniscus on myelogram

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Intradural Extramedullary1048708 Nerve Sheath Tumorsndash Schwannomas Neurofibromas

Ganglioneuroma Neurofibrosarcoma1048708 Meningiomas1048708 Lipomas1048708 mets

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Intramedullary1048708 Ependymoma 301048708 Astrocytoma 301048708 Misc 30

ndash rare GBM dermoid epidermoid teratoma lipoma hemagioblastomandash very rare neuroma metsndash extremely rare cholesteatoma oligodendroglioma lymphoma

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Treatment

Surgeryrecommended for benign and malignant primary spinal cord tumors the role of surgery in spinal metastasis or cancer that has spread to the spine is controversial Recent developments in imaging as well as new surgical tools and techniques such as ultrasonic aspirators and lasers have significantly expanded the role of surgery as an intervention

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

For metastatic tumors with spinal cord compression some neurosurgeons may perform surgery in selected patients to relieve pressure and pain reconstruct or stabilize the spine preserve mobility and bowel and bladder function and to maximize quality of life

Some doctors may only recommend surgery for patients with a single metastatic tumor and no evidence of cancer growing at another site

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Radiation Therapy

Most patients with primary spinal cord tumors will not require radiation therapy

Radiation however is used to treat spinal cord compression due to metastatic cancer or cancer that has spread from other locations

Other targets of radiation include some primary cancers of the spine and more rarely benign or low-grade spinal cord tumors that cannot be completely removed surgically

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Chemotherapy

Chemotherapy may be recommended in adults for spinal gliomas that progress after surgery and radiation

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50

Thank you

• Paediatric Tumours
• Pediatric Neurosurgical Neuropathology
• CNS tumors pediatric vs adult
• Brain tumors intro
• Primary brain tumors intro
• Clinical presentation
• CNS tumors diagnosis
• CNS tumors location
• CNS tumors location (2)
• Pilocytic astrocytomas
• Pilocytic astrocytomas (2)
• Astrocytoma - high grade
• Glioblastoma (grade IV)
• Pontine glioma
• Medulloblastomas
• Medulloblastoma
• Ependymoma
• Meningiomas
• Meningiomas (2)
• Ganglioglioma
• Craniopharyngioma
• Choroid plexus papilloma
• Germ cell tumors
• Metastatic tumors
• Other tumors
• Hereditary syndromes
• Slide 27
• Slide 28
• Compression Syndromes 1048708 Anterior ndash bilateral weakness dissoc
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Slide 44
• Slide 45
• Treatment
• Slide 47
• Slide 48
• Slide 49
• Slide 50