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Tumores Cerebrales ROSA L.PEA DOMINGUEZ 209-24741The complex shape of the adult brain is determined during embryogenesis by flexures that form early in development. These bends are due to tremendous cell proliferation, differential growth, and because the brain develops in the confined space of the cranial vault. The anterior neuropore closes at about the 24th day and the posterior neuropore closes on the 26th day. During the 4th week the expanded cephalic portion of the neural tube, which forms the brain, subdivides into 3 primary vesicles, forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The optic vesicle of the forebrain appears early, even before closure of the anterior neuropore. The caudal portion of the neural tube, which forms the spinal cord, remains essentially a simple tube. By about the end of the 3rd week this 3 part brain begins to assume a C-shape by the formation of cephalic flexure at the level of the mesencephalon; at the end of the 4th week a cervical flexure develops between the hindbrain and spinal cord.By the end of the 4th week the 3 part brain begins to develop 5 vesicles. The forebrain (prosencephalon) gives rise to, a) the paired lateral telencephalic vesicles which bud off from the prosencephalon and will become the cerebral hemispheres and b) the diencephalon (from which the optic vesicles extend). At the cephalic flexure, the mesencephalon remains tubular and undivided. The hindbrain (rhombencephalon) subdivides into a metencephalon and a more caudal myelencephalon. In the 5 vesicle stage (6th week) the pontine flexure develops in the rhombencephalon which divides it into a metencephalon and myelencephalon. The metencephalon is more cranial and forms the pons and cerebellum; the myelencephalon becomes the medulla. The presumptive site of the cerebellum is seen as the rhombic lips at the cranial edge of the thin roof of the 4th ventricle. A depression develops in the prosencephalon which defines the telencephalon from the diencephalon. Subsequent growth of the telencephalon will cause it to expand dorsally, caudally, laterally, and inferiorly.

Tumores Cerebrales: Epidemiologia Tumores Cerebrales : Factores Etiolgicos 4The complex shape of the adult brain is determined during embryogenesis by flexures that form early in development. These bends are due to tremendous cell proliferation, differential growth, and because the brain develops in the confined space of the cranial vault. The anterior neuropore closes at about the 24th day and the posterior neuropore closes on the 26th day. During the 4th week the expanded cephalic portion of the neural tube, which forms the brain, subdivides into 3 primary vesicles, forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The optic vesicle of the forebrain appears early, even before closure of the anterior neuropore. The caudal portion of the neural tube, which forms the spinal cord, remains essentially a simple tube. By about the end of the 3rd week this 3 part brain begins to assume a C-shape by the formation of cephalic flexure at the level of the mesencephalon; at the end of the 4th week a cervical flexure develops between the hindbrain and spinal cord.By the end of the 4th week the 3 part brain begins to develop 5 vesicles. The forebrain (prosencephalon) gives rise to, a) the paired lateral telencephalic vesicles which bud off from the prosencephalon and will become the cerebral hemispheres and b) the diencephalon (from which the optic vesicles extend). At the cephalic flexure, the mesencephalon remains tubular and undivided. The hindbrain (rhombencephalon) subdivides into a metencephalon and a more caudal myelencephalon. In the 5 vesicle stage (6th week) the pontine flexure develops in the rhombencephalon which divides it into a metencephalon and myelencephalon. The metencephalon is more cranial and forms the pons and cerebellum; the myelencephalon becomes the medulla. The presumptive site of the cerebellum is seen as the rhombic lips at the cranial edge of the thin roof of the 4th ventricle. A depression develops in the prosencephalon which defines the telencephalon from the diencephalon. Subsequent growth of the telencephalon will cause it to expand dorsally, caudally, laterally, and inferiorly.

Sndromes Relacionados con Tumores Cerebrales Tumores Cerebrales : Factores Etiolgicos Tumores Cerebrales: Fisiopatologa

6The complex shape of the adult brain is determined during embryogenesis by flexures that form early in development. These bends are due to tremendous cell proliferation, differential growth, and because the brain develops in the confined space of the cranial vault. The anterior neuropore closes at about the 24th day and the posterior neuropore closes on the 26th day. During the 4th week the expanded cephalic portion of the neural tube, which forms the brain, subdivides into 3 primary vesicles, forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The optic vesicle of the forebrain appears early, even before closure of the anterior neuropore. The caudal portion of the neural tube, which forms the spinal cord, remains essentially a simple tube. By about the end of the 3rd week this 3 part brain begins to assume a C-shape by the formation of cephalic flexure at the level of the mesencephalon; at the end of the 4th week a cervical flexure develops between the hindbrain and spinal cord.By the end of the 4th week the 3 part brain begins to develop 5 vesicles. The forebrain (prosencephalon) gives rise to, a) the paired lateral telencephalic vesicles which bud off from the prosencephalon and will become the cerebral hemispheres and b) the diencephalon (from which the optic vesicles extend). At the cephalic flexure, the mesencephalon remains tubular and undivided. The hindbrain (rhombencephalon) subdivides into a metencephalon and a more caudal myelencephalon. In the 5 vesicle stage (6th week) the pontine flexure develops in the rhombencephalon which divides it into a metencephalon and myelencephalon. The metencephalon is more cranial and forms the pons and cerebellum; the myelencephalon becomes the medulla. The presumptive site of the cerebellum is seen as the rhombic lips at the cranial edge of the thin roof of the 4th ventricle. A depression develops in the prosencephalon which defines the telencephalon from the diencephalon. Subsequent growth of the telencephalon will cause it to expand dorsally, caudally, laterally, and inferiorly.

Mecanismo de crecimiento Expansin Crecen sobre un punto central produciendo compresin y destruccin del tejido adyacente

Infiltracin o Invasin

Mecanismo de crecimiento

Otros Mecanismos

Mecanismo de crecimiento

Tumores Cerebrales: Clasificacin Neuroepiteliales Astrocitos----------------------------Astrocitomas: Pilocitico Pleomorfico Gigante subependimario Difuso Oligodendrocitos -----------------Oligodendrogliomas: Cel.Ependimarias -----------------EpendimomaMixtos -------------------------------OligoastrocitomaPlexos Coroides--------------------Papiloma CarcinomaNeuronales -------------------------Gangliocitoma Gangliocitoma displasicos infantil Tumor neuroepitelial Disembrioplastico Ganglioglioma Neurocitoma Estesioneuroblastoma Pineales------------------------------Pinealocitoma Pinealoblastoma Mixto Embrionarios ----------------------Tumores neuroectodermicos primitivos: Meduloblastoma Neuroblastoma Pinealoblastoma Retinoblastoma Ependimoblastoma

Intraxiales o intraparenquimatosos Metstasis 10The complex shape of the adult brain is determined during embryogenesis by flexures that form early in development. These bends are due to tremendous cell proliferation, differential growth, and because the brain develops in the confined space of the cranial vault. The anterior neuropore closes at about the 24th day and the posterior neuropore closes on the 26th day. During the 4th week the expanded cephalic portion of the neural tube, which forms the brain, subdivides into 3 primary vesicles, forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The optic vesicle of the forebrain appears early, even before closure of the anterior neuropore. The caudal portion of the neural tube, which forms the spinal cord, remains essentially a simple tube. By about the end of the 3rd week this 3 part brain begins to assume a C-shape by the formation of cephalic flexure at the level of the mesencephalon; at the end of the 4th week a cervical flexure develops between the hindbrain and spinal cord.By the end of the 4th week the 3 part brain begins to develop 5 vesicles. The forebrain (prosencephalon) gives rise to, a) the paired lateral telencephalic vesicles which bud off from the prosencephalon and will become the cerebral hemispheres and b) the diencephalon (from which the optic vesicles extend). At the cephalic flexure, the mesencephalon remains tubular and undivided. The hindbrain (rhombencephalon) subdivides into a metencephalon and a more caudal myelencephalon. In the 5 vesicle stage (6th week) the pontine flexure develops in the rhombencephalon which divides it into a metencephalon and myelencephalon. The metencephalon is more cranial and forms the pons and cerebellum; the myelencephalon becomes the medulla. The presumptive site of the cerebellum is seen as the rhombic lips at the cranial edge of the thin roof of the 4th ventricle. A depression develops in the prosencephalon which defines the telencephalon from the diencephalon. Subsequent growth of the telencephalon will cause it to expand dorsally, caudally, laterally, and inferiorly.

Extraxiales o extraparenquimatosos Aracnoides-------------------Meningiomas Nervios y Vainas ------------Schwanomas Neurofibromas Hematopoyticos-----------Linfoma Plasmocitoma Cels.Germinales-------------Germinoma Carcinoma Embrionario Tumor de Seno Endodrmico Coriocaricoma Teratoma Quistes------------------------Quiste de la Bolsa de Rathke Quistes Epidermoides Quiste EnterogenicoHipofisis-Hipotalamo ------Adenoma de Hiposis craneofaringioma Tumores vecinos ------------Glomus ---------------------------------Chemodectoma Notocorda --------------------------------Cordoma Condrocitos -----------------------------Condroma Sarcomas A distancia Metstasis ------Hematgenas LCR

Tumores Cerebrales Extraaxiales :Clasificacin 12The complex shape of the adult brain is determined during embryogenesis by flexures that form early in development. These bends are due to tremendous cell proliferation, differential growth, and because the brain develops in the confined space of the cranial vault. The anterior neuropore closes at about the 24th day and the posterior neuropore closes on the 26th day. During the 4th week the expanded cephalic portion of the neural tube, which forms the brain, subdivides into 3 primary vesicles, forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The optic vesicle of the forebrain appears early, even before closure of the anterior neuropore. The caudal portion of the neural tube, which forms the spinal cord, remains essentially a simple tube. By about the end of the 3rd week this 3 part brain begins to assume a C-shape by the formation of cephalic flexure at the level of the mesencephalon; at the end of the 4th week a cervical flexure develops between the hindbrain and spinal cord.By the end of the 4th week the 3 part brain begins to develop 5 vesicles. The forebrain (prosencephalon) gives rise to, a) the paired lateral telencephalic vesicles which bud off from the prosencephalon and will become the cerebral hemispheres and b) the diencephalon (from which the optic vesicles extend). At the cephalic flexure, the mesencephalon remains tubular and undivided. The hindbrain (rhombencephalon) subdivides into a metencephalon and a more caudal myelencephalon. In the 5 vesicle stage (6th week) the pontine flexure develops in the rhombencephalon which divides it into a metencephalon and myelencephalon. The metencephalon is more cranial and forms the pons and cerebellum; the myelencephalon becomes the medulla. The presumptive site of the cerebellum is seen as the rhombic lips at the cranial edge of the thin roof of the 4th ventricle. A depression develops in the prosencephalon which defines the telencephalon from the diencephalon. Subsequent growth of the telencephalon will cause it to expand dorsally, caudally, laterally, and inferiorly.

Tumores Cerebrales Extraaxiales :Clasificacin Tumores de la Regin del Angulo Pontocerebeloso

Schwannomas Vestibulares Meningiomas Quiste Epidermoides

Tumores Cerebrales Extraaxiales :Clasificacin Tumores Cerebrales Extraaxiales :Clasificacin Tumores interventriculares o Paraventriculares

Ventrculos Laterales Meningioma PapilomaSubependimomaTercer ventrculo Quiste coloides Craneofaringioma Cuarto ventrculo Meduloblastoma EpendimomaAstrocitomaHemangioblastomaMetstasis T. Epidermoide

Tumores Cerebrales Extraaxiales :Clasificacin

Tumores Cerebrales : Clnica Tumores Cerebrales : Diagnostico

Clnico TAC Cerebral RMArteriografa Cerebral PETEspectroscopia por RM Ecografas Centellografia Biopsia o Ciruga Dficit Neurolgico Meningitis AspticaAlteraciones Mentales Recidiva del Tumor Hidrocefalia Epilepsia Tumores Cerebrales : Complicaciones

Tumores Cerebrales : Tratamiento

Tumores Intraxiales Tumores Cerebrales Neuroepiteliales Astrocitoma Difuso Astrocitoma Pilocitico GangliomaGangliocitomaOligodendroglioma de Bajo Grado Ependimoma no Anaplasico Astrocitoma Anaplasico Oligodendroglioma Anaplasico Ependimoma Anaplasico Glioblastoma Multiforme o Heteromorfo Tumores de Grado Bajo Crecimiento lento Adultos y jvenes Menores de 40aos Supervivencia de 7-10aos Crisis Epilpticas Lbulo temporal ,frontal posterior ,parietal anterior RM: sin gran efecto de masa ,no hay edema circundante Complicacin : malignizacion a grados histolgicos superiores

Tumores Alto Grado Alta tasa de crecimiento Adultos 45-65aos Sx focal e Hipertensin Endocraneal RM: edema, efecto de masa ,aspecto heterogneo en reas de necrosis y hemorragias

Tumores Cerebrales Neuroepiteliales:Astrocitomas Clula de sostn de aspecto estrellado que se encuentran en todo el SNC, forman un armazn estructural y de soporte para las neuronas y los capilares. Gracias a sus prolongaciones citoplasmticas. Tambin mantienen la integridad de la barrera hematoencefalica.Grupo deneoplasias intracraneales primarias delsistema nervioso central que aparece en el parnquima cerebral y que rara vez produce metstasis a otros tejidos. Laclula predominante en estos tumores deriva de los astrocitosLos astrocitos son clulas finas que rodean y envuelven tanto neuronas como capilares sanguneos por medio de estructuras especializadas llamadas pies astrocticos, que constituyen el sustrato anatmico de la unidad funcional llamada barrera hematoenceflica Tumores Cerebrales Neuroepiteliales: Astrocitomas 26.6% de los tumores cerebrales.

La mayor incidencia de los Astrocitomas cerebrales ocurre durante la tercera y cuarta dcadas de la vida Algunas veces aparecen en los nios Astrocitomas talmicos.

El Sistema de estadificacion histologica mas usado es el descrito por la OMS.Tumores Cerebrales Neuroepiteliales-Astrocitomas : Clasificacin

Astrocitoma Pilocitico : Grado I

Clulas elongadas dispuestas en forma paralelas y con haces y con haces compactos de filamentos que poseen aspectos de pelos .

Astroctoma Piloctico (PCA) es la denominacin aceptada para los tumores denominados como astrocitoma qustico cerebeloso, astrocitoma piloctico juvenil,glioma ptico y glioma hipotalmico.Astrocitoma Gigantocelular Subependimario

Se considera un glioma de grado I.

Tumor circunscrito.

Asociado a esclerosis tuberosa.

Pared de los ventriculos laterales.Histologicamente estan compuestos por astrocitos gigantes con frecuente infiltrado linfocitario.

Astrocitoma Anaplasico:Grado IIIEl crecimiento y aspecto histolgico del astrocitoma anaplsico son similares a los de los astrocitomas benignos.

Xantoastrocitoma Pleomrfico

LocalizacinEn nios, fundamentalmente en lnea media (cerebelo, tronco,nervio ptico), en adultos, en los hemisferios cerebrales

TratamientoCiruga, radioterapia y quimioterapia. las tcnicas de imagen suelen ser inespecficas y es necesaria la biopsia para el diagnstico. Los Astrocitomas se deben remover siempre que sea posible mediante reccecion quirrgica.

Pronostico Astrocitoma Grado IV : Glioblastoma Multiforme

Tumor primario mas frecuente del sistema nervioso central que afecta los hemisferios cerebrales principalmente lbulos frontales y parietales y se desarrolla a partir de astrocitos.

GBM: CONCEPTO

GBM: EPIDEMIOLOGIA GBM: CARACTERISTICAS GBM:CLASIFICACION

GBM: MANIFESTACIONES CLINICAS Cefalea Hipertensin Endocraneal Crisis epilpticas

GBM:DIAGNOSTICO

TAC:RM

RM Lesin heterognea, poco delimitada, necrosis central, pared gruesa e irregular. GBM:DIAGNOSTICO

GBM:TRATAMIENTO GBM:PRONOSTICO

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