How Do I Choose the Best Glioma Treatment?

Glioma is called glioma for short, also known as glioblastoma. It is the most common primary central nervous system tumor, accounting for about half of all intracranial primary tumors. Broadly, it refers to all tumors of neuroepithelial origin. Narrow sense refers to tumors derived from various types of glial cells. According to the World Health Organization (WHO) classification scheme in 1999, it is divided into astrocytoma, oligoglioma, ependymal tumor, mixed glioma, choroid plexus tumor, neuroepithelial tissue tumor of uncertain origin, and nerve Mixed neuronal and neuronal glioma, pineal parenchymal tumor, embryonic tumor, neuroblastoma tumor.

Basic Information

nickname: Glioma
English name: neuroglioma, neurogliomatosis, neurospongioma, glioma

Visiting department: neurosurgery
Contagious: no

Causes of glioma

The cause of this disease is not clear, and may be related to tumor origin, genetic factors, biochemical environment, ionizing radiation, nitroso compounds, polluted air, poor living habits, infection and other factors.

Classification of gliomas

Astrocytoma

It is the most common type of tumor in glioma.

Adults are more common in the cerebral hemisphere, while children are more common in the cerebellum. Can be divided into the following types:

(1) Benign astrocytoma Fibrous astrocytoma. Protoplasmic astrocytoma. Fatty astrocytoma.

(2) Anaplastic (malignant) astrocytoma is a malignant type in astrocytoma.

(3) Glioblastoma is the most malignant type of astrocytoma.

(4) Polymorphic yellow astrocytoma is a solid tumor located superficially in the brain.

(5) The subventricular giant cell astrocytoma is often associated with tuberous sclerosis.

(6) Hairy cell astrocytoma can be distributed in the cerebral hemisphere, hypothalamus area, anterior optic pathway, brain stem and cerebellum.

Oligoglioma

It can be divided into two levels: oligoglioma and anaplastic (malignant) oligoglioma.

3. Ependyma and anaplastic (malignant) Emangioma

It is a tumor that develops from the epithelium of the epithelium.

4. Mixed glioma

Is a glioma containing two glial cell components.

5. Choroid plexus tumor

There are two types of choroid plexus papillomas and choroid plexus carcinomas.

6. Neuroepithelial tumors of uncertain origin

Includes three lesions: astroblastoma, polar glioblastoma, and glioma disease.

7. Neurons and mixed neurogliomas

Including gangliocytoma, ganglioglioma, connective tissue-promoting infantile ganglioglioma, embryonic dysplastic neuroepithelial tumor, and central neuroblastoma.

8. Pineal Gland Tumor

Can be divided into pineal somatoma and pineal somatoblastoma, mixed / transitional somatic cell tumor, both of which are rare.

9. Embryonic tumor

Belonging to embryonic brain tumors are medullary epithelioma, neuroblastoma, ependygoblastoma, primitive neuroectodermal tumor, and medullary tumor.

10. Neuroblastoma tumors

Glioma test

Neuroimaging examination, such as CT plain scan.

Clinical manifestations of glioma

Astrocytoma

(1) Benign astrocytoma This tumor grows slowly and has a long course. Headaches and epilepsy are the first symptoms of tumors on the curtain, followed by fatigue and fatigue, facial muscle and limb muscle weakness, and increased intracranial pressure later. Patients with tumors in the cerebellar hemisphere appear dizzy, diminished in mobility, unstable gait, and ataxia in their limbs.

(2) Anaplastic (malignant) astrocytoma This tumor grows rapidly and has severe clinical symptoms, mainly headache, increased intracranial pressure, and focal neurological dysfunction.

(3) Glioblastoma usually has a sudden onset and rapid progress, with neurological dysfunction as the earliest symptom. Later, headaches and increased intracranial pressure occurred. About one-third of the patients had seizures, and some patients had significant mental decline, indifferent expression, slow response, cognitive impairment and memory decline.

(4) Polymorphic yellow astrocytoma is more common in adolescents and children.

(5) Subventricular giant cell astrocytoma can sometimes cause hydrocephalus.

(6) Hairy cell astrocytoma occurs mainly in children and is encountered in adults. The course is relatively mild. The clinical manifestations may be slightly different according to different tumor sites, including headache, increased intracranial pressure, hydrocephalus, etc. A few patients may have convulsions. The clinical features of tumor cases in the anterior vision are unilateral exophthalmos with visual impairment and strabismus. Brain stem tumor cases can be manifested as dizziness, ipsilateral cerebral nerve palsy, and contralateral hemiplegia. There are also cases of hydrocephalus.

Oligoglioma

The course is long and secondary seizures often occur in addition to the symptoms of increased intracranial pressure.

3. Ependyma and anaplastic (malignant) Emangioma

The clinical manifestation depends on the tumorigenesis site. The main symptoms are headache, nausea, vomiting, dizziness, pain in the back of the neck, and unstable walking.

4. Mixed glioma

The clinical manifestation depends on the tumorigenesis site.

Glioma diagnosis

Combined with clinical manifestations, diagnosis depends on neuroimaging.

Differential diagnosis of glioma

It should be differentiated from medullary tumor, ependymal tumor, hemangioblastoma, metastatic tumor, and cerebral infarction.

Glioma Treatment

The treatment of glioma is mainly surgical, but due to the invasive growth of the tumor, there is no obvious boundary with the brain tissue. Except for those with small early tumors and appropriate locations, it is difficult to make a complete resection. Generally, comprehensive treatment is recommended That is, postoperative combined with radiation therapy and chemotherapy can delay recurrence and prolong survival. And should strive for early diagnosis and timely treatment to improve the treatment effect.

Surgical treatment

The principle is to remove the tumor as much as possible while preserving nerve function. Those with smaller early tumors should strive for complete tumor resection. For larger tumors located in the frontal or temporal lobe, lobectomy can be performed together with the tumor. Tumors involving the cerebral hemisphere have hemiplegia in more than two lobes of the brain but have not invaded the basal ganglia, thalamus, and contralateral ones, and can also be used for hemisphere resection.

The tumor is located in the motor and speech area without obvious hemiplegia or aphasia. Care should be taken to maintain the nerve function to properly remove the tumor to avoid severe sequelae. Decompression of the temporal muscle or bone flap can be performed at the same time. Decompression can also be performed only after a biopsy. If thalamic tumor obstructs the third ventricle, it can be used as shunt, otherwise it can also be used as decompression.

Ventricular tumors can be cut from non-important functional areas into the ventricle according to the location of the ventricle. As far as possible, the tumor is removed to relieve the ventricular obstruction. Care should be taken to avoid damaging the tumor near the hypothalamus or brainstem to prevent danger. In addition to small nodular or cystic brain stem tumors can be resected, those with increased intracranial pressure can be used for shunt surgery.

In critical condition, the tumor on the screen should be given dehydration medication first, and at the same time, check and confirm as soon as possible, and then surgical treatment. Tumors of the posterior cranial fossa can be treated with ventricular drainage first, and the condition should be stabilized before surgery.

2. Radiation therapy

The sensitivity of different types of gliomas to radiation therapy varies. It is generally considered that poorly differentiated tumors are higher than well differentiated tumors. Myeloblastoma is the most sensitive to radiotherapy, followed by ependymal blastoma. Glioblastoma multiforme is only moderately sensitive. Astrocytoma, oligoglioblastoma, pineal cell tumor, etc Worse. For medullary tumors and ependymal tumors, because they are easy to spread with cerebrospinal fluid, whole spinal canal irradiation should be included.

3. Chemotherapy

Chemotherapy drugs with high fat-soluble properties that pass the blood-brain barrier are suitable for brain gliomas. The drug of choice should still be primarily fat-soluble.