Tumors

Benign Brain Tumors
Chordomas are benign, slow-growing tumors that are most prevalent in people between 50 to 60 years of age. They are most commonly located at the base of the skull and the lower part of the spine. While they may be benign, they can invade bone in adjacent areas and pressurise neural tissue. Chordomas are rare, making up only 0.2% of all primary brain tumors.

Treatment: These tumours most often require surgical resection which may be via an open approach or in some cases, an endonasal endoscopic approach.

Craniopharyngiomas are usually benign, but tend to be difficult to remove since they are located near critical structures which lie deep within the brain. Craniopharyngiomas commonly arise from a part of the pituitary gland which regulates hormones in the body. This results in most patients needing some form of hormone replacement therapy.

Treatment: These tumours most often require surgical resection which may be via an open approach or in some cases, an endonasal endoscopic approach.

Gangliocytomas, anaplastic gangliomas and gangliomas are rare tumors that include neoplastic nerve cells that are relatively well-differentiated, occurring primarily in young adults.

Glomus jugulare tumors most frequently are benign and typically located just below the skull base, right at the top of the jugular vein. These are the most common form of glomus tumour which themselves make up just 0.6% percent of head and neck neoplasms.

Meningiomas are the most common benign intracranial tumors, making up 10 to 15% of all brain neoplasms. However, only a very small percentage are malignant. Meningiomas, as the name suggests, originate from the meninges which are membrane-like structures surrounding the brain and spinal cord.

Pineocytomas occur mostly in adults and are usually benign. They arise from pineal cells, are often well-defined and tend to be non-invasive, slow to grow and homogeneous.

Pituitary adenomas are the most common intracranial tumors after gliomas, meningiomas and schwannomas. Most pituitary adenomas are benign and relatively slow-growing. Even when malignant, it is very unusual for pituitary tumors to spread elsewhere in the body. They are the most common disease to affect the pituitary by a long way affecting mostly people in their 30s or 40s, though they have been identified in children to.

Treatment: Most pituitary adenomas can be treated successfully through surgery using the endoscopic endonasal approach.

Schwannomas are benign brain tumors commonly found in adults. They comprise cells which normally provide ‘electrical insulation’ for the nerve cells and are therefore found along nerves. Schwannomas often simply displace the what is left of the normal nerve instead of invading it. Vestibular schwannomas (also called acoustic neuromas)
are the most common schwannoma. They arise from the eighth cranial nerve (also known as the vestibulocochlear nerve) which travels from brain to ear. Although such tumours are benign, they are responsible for serious complications and even death if allowed to grow and exert pressure on nerves and (eventually) the brain. They are also found in the spine and, less often, along nerves going to limbs.

Malignant Brain Tumors
Gliomas are the most widespread type of adult brain tumor, making up 78% of all malignant brain tumors. Gliomas arise from the supporting cells of the brain, called ‘glia.’ Glia are of three types – astrocytes, ependymal cells and oligodendroglial cells.

Glial tumors include the following:

  • Astrocytomas: These are the most commonly occuring glioma, comprising about half of all primary tumours of the brain and spinal cord. They develop from astrocytes which are part of the brain’s supportive tissue. Astrocytomas can occur in many parts of the brain, but they most commonly occur in the cerebrum. They affect people of all ages but tend to be more commonly found in adults and middle-aged men in particular. Astrocytomas found in the base of the brain most commonly occur in children or young people. They form the majority of children’s brain tumours. When occuring in children, they are considered low grade but, in adults, they are mostly high-grade.
  • Ependymomas are derived from a neoplastic transformation of the ependymal cells lining the ventricular system. They comprise 2 to 3% of all brain tumors, most of which are well-defined though some may not be.
  • Glioblastomas multiforme (GBM) is the most invasive type of glial tumor and can be composed of several different kinds of cells from astrocytes to oligodendrocytes. GBM tumors mostly grow at a rapid pace, spread quickly to other tissue. GBM is most common in people between the ages 50 and 70, and more so in men. They have a poor prognosis.
  • Medulloblastomas usually arise in the cerebellum and occur most commonly in children. These are high-grade tumors, but they commonly respond to radiation and chemotherapy treatment.
  • Oligodendrogliomas are tumours which are derived from the cells that make myelin (the insulation for the wiring of the brain).

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Other Types of Brain Tumors
Hemangioblastomas are usually found in the cerebellum and are slow-growing. Originating from blood vessels, they may be large and are often seen with a cyst. Hemangioblastomas are common in people between the ages of 40 and 60, and more so in men.

Treatment: The treatment for this is surgical excision through a craniotomy.

Rhadoid tumours are rather rare. They are very aggressive and spread through the central nervous system, often appearing in more than one part of the body, particularly the kidneys. While rhabdoid tumours can occur in adults, they occur more commonly in young children.

Treatment: The treatment for this is surgical excision through a craniotomy.

Cushing’s Disease
Chronic exposure to increased levels of the hormone cortisol (known as ‘hypercortisolism’), due to a pituitary tumour, can result in a condition called Cushing’s disease.

Treatment: The preferred treatment for Cushing’s is the removal of the tumour through the Endoscopic Endonasal Approach.

Neurofibromatosis
Neurofibromatosis is a rare genetic disorder that causes benign tumors of the nerves and growths in various parts of the body. The effects of it are varied – some patients barely exhibit symptoms while others have severe neurological issues. Primarily there are two kinds of neurofibromatosis – NF1 (Type 1) and NF2 (Type 2).

Nf1 is seen to manifest at either birth or in early childhood and is characterised by benign tumors on or under the skin and light brown spots. This may be accompanies by the enlarged and deformed bones. There may also be an unnatural curvature of the spine (scoliosis). People suffering from NF1 sometimes develop brain tumors or
tumours on cranial nerves or the spinal cord. NF2 might appear in childhood, adolescence or even early adulthood and is characterised (among other things) by benign tumors of the auditory nerves.

Recently, a third disorder, which is related, has been recognised – schwannomatosis. It has much in common with NF1 and NF2 but recent research leads us to believe it is a completely distinct genetic disease. Schwannomatosis is more commonly diagnosed in adults over the age of 30.