Oncology
Brain Tumors
Oncology

Brain Tumors

Dexamethasone first for edema; surgical resection + radiation/chemo per type.

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Symptomatic mass lesions

  • Progressive headache + focal deficits + new seizures + vasogenic edema → IV dexamethasone (stabilizes BBB)
  • Mannitol is for cytotoxic edema / impending herniation
  • AVOID lumbar puncture (herniation risk)

Tumor types

  • Brain metastases: multiple ring-enhancing at gray-white junction (lung, breast, melanoma); SRS for limited, WBRT for many
  • Meningioma: extra-axial dural-based mass in middle-aged woman; 'dural tail'; NF2; observe small asymptomatic
  • Vestibular schwannoma (acoustic neuroma): progressive unilateral SNHL + tinnitus + imbalance; MRI IAC; bilateral → NF2
  • Glioblastoma multiforme: large irregular rim-enhancing mass crossing corpus callosum ('butterfly'); Stupp protocol (resection + RT + temozolomide)
  • Craniopharyngioma: child + bitemporal hemianopsia + GH/DI deficiency + calcified suprasellar mass

Phakomatoses

  • NF1: café-au-lait, Lisch nodules, axillary freckling, optic gliomas
  • NF2: bilateral vestibular schwannomas — annual brain MRI + audiometry
  • Tuberous sclerosis: ash leaf spots, shagreen patch, subependymal nodules → SEGAs; cardiac rhabdomyomas; renal AML; vigabatrin for infantile spasms
  • Sturge-Weber: port-wine stain + leptomeningeal angioma + seizures
  • Von Hippel-Lindau: hemangioblastomas, RCC, pheochromocytoma
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