A tumor is an abnormal mass of tissue that grows on or inside the body. It is known as primary if located where its growth first started, or secondary if it began growing elsewhere in the body and metastasized, or spread, to its present location. Most primary brain tumors do not metastasize outside the brain.
Inside the skull, tumors can grow almost anywhere: within brain tissue, from the meninges, or inside the ventricular system. They can be encapsulated (self-contained) or interwoven with blood vessels, nerves, or other brain structures from which they cannot be removed without devastating consequences. Metastatic tumors are usually well localized, may occur alone or in clusters, and may spread throughout much of the brain.
A benign tumor usually is encapsulated, does not spread to other areas of the body, grows slowly, and often causes problems by compressing brain tissue. A malignant tumor grows uncontrollably, spreads throughout the brain, and destroys brain tissue.
What symptoms can a brain tumor cause?
A brain tumor may at first cause the vague feeling of being "unwell." This may be followed by other, more specific symptoms: dull, persistent headache; nausea or vomiting; generalized weakness; vision problems. Because the left side of the brain governs the right side of the body, and vice versa, a tumor will cause specific weakness or loss of movement on the opposite side of the body. Some symptoms may be caused by the increased pressure inside the skull from brain swelling, which can temporarily be treated with a steroid medication.
Because brain tissue is irritated by the tumor, the brain can temporarily "short-circuit" as its normal electrical activity is interrupted. These periods of uncontrolled brain activity can cause seizures, which may be generalized and cause contractions of all parts of the body, loss of consciousness or bladder and bowel function. The seizures may instead be of a focal nature, affecting only one arm, a leg, or part of the face. Seizures usually can be controlled with anticonvulsant medications.
How is it evaluated?
A detailed history-taking of the patient's symptoms and a physical examination are done first, followed by any of several tests, such as x-ray studies, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and angiograms. All findings are used to evaluate the patient's symptoms, determine the tumor's exact location, and provide the physician with a tentative diagnosis of the tumor type.
During surgery, ultrasound imaging may be used to pinpoint the tumor's precise location and help the surgeon plan his approach for its removal.
If an emergency craniotomy is required, an extensive workup may not be possible.
Growing from abnormal cells of the meninges, meningioma is a slow-growing tumor that shares the dura's rich blood supply. It is very often attached to dura and so may be immediately visible when the dura is opened.
It is usually a benign tumor and well encapsulated, but removal may be complicated by its size, firmness, and attachment to vital blood vessels or brain tissues.
A large meningioma or one that is difficult to remove may require a long, tedious surgery and can cause further brain swelling and blood loss.
Often the dura removed during tumor surgery may be replaced with other body tissue (fascia) or a dura substitute.
Glial cells support the brain's functioning nerve network and are the site of tumors inside the brain. Gliomas are "graded" according to their degree of malignancy.
Often when the dura is opened, the brain is swollen but otherwise may appear normal.
The "center" of the glioma may readily be identified, but because the tumor gradually spreads into surrounding tissue the boundaries of a glioma are harder to identify.
It may take months for the cells around the edges of the tumor to appear abnormal, yet they can be affected long before they "show" themselves. This is why glioma usually cannot be removed completely, as even one remaining cell can continue the tumor's growth.
Often lying close to the brain's surface, where it irritates the normal tissue around it, a metastatic tumor is one that began in another body organ and traveled in the bloodstream to the brain.
Grown from a "seed" of non-brain tissue (from the breast, kidney, or lung, for example) a metastatic tumor often can be separated from the surrounding brain more easily. If only a single lesion exists, all or part of it usually can be surgically removed.
The skull is made up of 22 bones: the cranium includes eight bones that surround and protect the brain and 14 bones that form the face. In adults, all but one of the skull bones are fused together by immovable joints called sutures. The sutures lock the edges of the skull bones together, like pieces in a puzzle, to form a structure that is both rigid and strong. The mandible, or lower jaw, the only moveable skull bone, allows the mouth to open and close.
In newborns, the skull bones are not completely fused; they are linked by fibrous membrane called fontanels. Fontanels allow the skull to be compressed slightly during birth and accommodate growth of the brain during early infancy. By one-and-a-half years of age, the skull sutures have formed and the fontanels have disappeared.
The frontal bone forms the forehead. Two parietal bones form the sides of the cranial roof. Two temporal bones form the lower cranial sides. The occipital bone forms the cranial rear and floor. The ethmoid bone forms part of the nasal cavity. Shaped like a butterfly, the sphenoid bone forms the middle part of the cranial floor.
The 14 facial bones provide the structure of the face and form the openings through which food, water, and air enter the body. Each of the following facial bones are paired: the maxillae form the upper jaw and front of the hard palate; the zygomatic bones form the cheeks; the nasal bones form the bridge of the nose; the lacrimal bones form part of the orbit, or eye socket; the palatine bones form the rear of the hard palate; and the inferior nasal conchae divide the nasal cavity. The vomer is a single bone that makes up part of the nasal septum, which divides the nostrils, and the mandible forms the lower jaw. The maxillae and mandible secure the teeth.
Small holes in the skull bones, called foraminae, and canals enable blood vessels, such as the carotid arteries and nerves, to enter and leave the skull. The spinal cord passes through the largest hole, called the foramen magnum, in the base of the cranium to join the brain. The occipital condyles on either side of the foramen magnum articulate with the first vertebra (C1) of the spine to permit up-and-down movement of the head.
The Nervous System
The nervous system is a communication network that controls and coordinates most body actions. People are not generally conscious of some of these activities as they occur, such as regulating body temperature, breathing, or heart rate. Others, we consciously control, such as movement, talking, eating, and thinking.
The nervous system has two main parts: the central and the peripheral nervous system. The brain and spinal cord make up the central nervous system, or CNS. The nerves branching off the central nervous system make up the peripheral nervous system, or PNS. The PNS consists of nerve bundles made up of sensory and motor neurons.
The nervous system is made up of cells called neurons. Neurons are long, thin cells that transmit electrical impulses. Neurons have many branched endings, called dendrites, which receive impulses from other neurons. An axon, or nerve fiber, carries nerve impulses to other neurons or to muscle. Neurons do not touch, but are separated by a tiny gap called a synapse. When an impulse arrives at the end of an axon, it releases chemicals that generate an impulse in the dendrites of the neighboring neuron.
There are three types of neurons: sensory, motor, and association. Sensory neurons transmit nerve impulses from sense organs (eyes, ears, nose, tongue, and touch) to the brain. They also carry nerve impulses to the brain and spinal cord. Motor neurons transmit nerve impulses from the brain and spinal cord to a specific area of the body. A nerve impulse to a muscle, for example, may cause it to contract. Association neurons make up 90 percent of all neurons and are found only in the brain and spinal cord.
Nerves consist of bundles of both sensory and motor neurons.
The brain is the control center of the nervous system. It enables us to think, feel, and move. The brain constantly receives information and sends out instructions to the body through the spinal cord and the body's vast network of nerves. There are 12 pairs of cranial nerves branching off the brain. These nerves relay impulses from the sensory organs, such as the eyes or ears. Thirty-one pairs of spinal nerves branch off the spinal cord, exiting between each level of vertebrae. These nerves relay impulses to and from the rest of the body.
The largest part of the brain is the cerebrum, which controls the most sophisticated functions, such as thought, imagination, memory, emotion, speech and sensory perception. The human cerebrum is quite large. It has two halves, or hemispheres. A band of nerve tissue, called the corpus callosum, links two halves to allow them to exchange information. Each hemisphere is covered by a layer of gray tissue, called the cerebral cortex, which is responsible for the higher functions of the brain, including conscious thought. The cortex is composed of sulci (folds) and gyri (bulges), which together provide a large surface area in the limited space inside the skull.
Brain tissue is soft and delicate, and requires protection. In addition to the protection provided by the skull, the brain is surrounded by: the connective tissue membranes, or meninges; the dura mater; the arachnoid layer; and the pia mater. Beneath the arachnoid matter is a wide space filled with cerebrospinal fluid (CSF). This fluid forms a liquid cushion that reduces the weight of the brain and protects it from knocks and jolts. CSF also helps the brain to receive nourishment.
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