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BRAIN TUMOR

DEFINITION

Brain tumor is a invasive neoplasm of the intra cranial portion that occupies the space within the skull. Commonly manifested with increased ICP, seizure and other neurological symptoms.

Classification of brain tumor

Intra cerebral tumors


Gliomas- infiltrate any portion of the brain; most common type of brain tumor. a) Astrocytomas (grades 1 and 2)
b) Glioblastomas multiforme (astrocytoma grade 3 and 4)

c) Oligodendrocytoma (Oligodendroglia) d) Ependymoma (Lining of ventricles called ependymal cells) e) Medulloblastoma (Neuroepithelial origin)

Tumors arising from supporting structures

a) Meningiomas (brain and meninges) b) Acoustic Neuromas ,schwanoma Neuromas . c) Pituitary adenomas

Causes
Abnormal development in the womb Viruses Hormones Chemicals Ionizing radiation Specific Genetic Abnormalities. Numerous specific brain tumors, including glioblastomas, Ana plastic astrocytomas, and Medulloblastoma, are the result of abnormal or missing genes:

Causes

Several defective genes are involved in the cancer process. Genes that cause cancer proliferation (called oncogens) and those that normally suppress tumors but are defective (tumor suppressor genes) may play separate roles in a step-by-step process leading to primary brain cancer. Several avenues of investigation are in progress to determine both basic causes and the triggers for such genetic defects.

Pathophysiology

CLINICAL MANIFESTATION

General symptoms
headache, vomiting, papilledema, personality changes, increased ICP Symptoms related to tumor area frontal area Inappropriate behavior Inattentiveness Inability to concentrate

Parietal lobe tumors loss of left and right discrimination seizure activity Temporal lobe tumor hallucination (auditory, visual, olfactory) receptive aphasia depression childish behavior

Occipital lobe tumors visual disturbance visual hallucination Cerebellum tumors ataxia incordination Pituitary tumors
Acromegaly , gigantism.

INVESTIGATIONS

History collection and physical examination Visual field and fundoscopic examination Skull films Computed tomography Electroencephalogram Cerebral angiography Lumbar puncture MRI Endocrinal studies

Management

Surgical management Radiation therapy Chemotherapy

Surgical management

Craniotomy (depending on the site) Shunt in case of non communicating tumors causing hydrocephalus Laser surgeries Use of gamma knifes Interventional radiotherapy Burr hole for biopsy

Pharmacological management
Drugs used are

Dexamethasone (decadron) to reduce cerebral edema Phenytoin to prevent seizure activity Antiedematic drugs ( glycerol, mannitol ) Antibiotics

Chemotherapy

Radiotherapy and Chemotherapy (Radio chemotherapy). Combining chemotherapy with radiotherapy is beneficial in some patients with high-grade tumors.

Radiation therapy

Radiotherapy plays a central role in the treatment of most brain tumors, whether benign or malignant. Radiotherapy after Surgery. Even when it appears that the entire tumor has been surgically removed, microscopic cancer cells often remain in the surrounding brain tissue. Radiation targets the residual tumor with the goal of reducing its size or stopping its progression.

Nursing management

Pre-operative management

History regarding condition are collected Investigations are done to rule out location and type Provide information regarding operation and possible complication after surgery One the day of surgery- consent, physical preparation, ready investigations, and premedication.

Intraoperative care

Prevention of hypotension Prevention of hypothermia and hyper thermia Prevention of hyper ventilation Prevention of air embolism if patient is in sitting position Prevention of burns if diathermy is used

Post operative care

Post operative notes History of neurological status of patient Type of surgery ,current neurological baseline assessment Review of post operative order Other care like head end elevation, bed rest, avoid sneeze and cough.

Health Education
To provide information about chemotherapy side effects, complication of surgery, and care of the child in post operative period. And also the parents are taught about how to analyze he increased ICP, and to treat emergency management of seizure.

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