Tumors of the cerebellum

From benign tumors in the cerebellum are most often found infiltrative growing astrocytomas related to neuroectodermal row, and limited angioretikulez related to meningo-vascular number of tumors. Astrocytomas and angioretikulez in most cases cystic reborn, there may be a small site and the big sizes cystic cavity.
Among malignant tumors of the cerebellum first frequency in children and adolescents is medulloblastoma, then sarcoma, while adults - cancer metastasis. Medulloblastoma is an extremely fast growing tumor, it affects mostly the worm M, spreading further into hemispheres and spreading the roof of the fourth ventricle, is embedded in its cavity, usually leaving unaffected the bottom of the ventricle. This cancer spreads and spreads on subarachnoid spaces. Sarcoma (primary) cerebellum is represented as a node thick consistency, krupnosortnogo structure. Filumena tumor from M. during the operation is not difficult.
The clinical picture of cerebellar tumors characterized by progressive cerebellar and approaches vestibular symptoms associated with the local defeat cerebellar tissue, stem syndrome-specific stem compression level of the posterior cranial fossa, as well as from functional disorders of the cranial nerves and the syndrome of increased intracranial pressure, due to ventricular hydrocephalus.
To stem syndrome characterized by vomiting, depending on the stimulation of nerve formations within the posterior cranial fossa; it arises out of a headache attack, sometimes simultaneously with dizziness, sometimes with sharp movements, forced change of head and trunk. Vomiting due to increased intracranial pressure occurs with an increase in headaches.
Of oculomotor violations of the most alarming are the four-colmnia paresis, and paralysis of the eye upwards, indicating progressive compression of the trunk. In the period of increase of intracranial pressure is often observed diplopia. Spontaneous nystagmus is celebrated in most cases, tumors of the cerebellum. Violations of posture and position manifested fixed position of the head, with crowding her back or forward, as well as the preferred position in bed-side hemisphere, where the tumor is located. If the tumor affects the area of the middle brain and red kernel ailments tone type decerebration rigidity. The defeat of the trigeminal nerve likely decline corneal reflexes first side cerebellar hearth, and then bilateral their reduction. Dysfunction of the IX-X pairs of cranial nerves is a late symptom, when paresis of the soft palate are identified on one side or predominantly on one side.
Typical for tumors of the posterior cranial fossa is a syndrome of the omission of the cerebellar tonsils (tonsilla cerebelli - education-located at the back of the brain sails, corresponding to the tongue of the worm) and abuse in great occipital hole. The posterior cranial fossa is limited on all sides stubborn bone walls, except situated on top of cerebellar nameta with paginaweb hole, and bottom - funnel great occipital hole leading into the spinal canal. Therefore, the offset of M and trunk can occur only in two directions: downwards, into the great foramen, and upward, in bachinovo hole. With the increasing hypertension within the posterior cranial fossa, as well as in acute swelling of the brain is filling the brain or tumor tissue backup liquor spaces, filling a large tank lowered tonsils with subsequent development grieving infringement tonsils between stubborn bone edge of the great occipital foramen and shackle the first vertebra on the one hand and oblong brain. This is accompanied by a pronounced compression of the lower divisions of the medulla oblongata with the occurrence of severe bulbar disorders, expressed respiratory and cardiovascular disorders.
Symptoms occlusive attack mainly associated with rapidly increasing delay outflow of cerebrospinal fluid from the ventricular system as a result of full or nearly full temporary or permanent blocking of ways outflow. Hypertension causes of occlusive hydrocephalus, increased ventricular pressure and the compression of the trunk. There are sharp headaches, vomiting, forced position with incorrect installation of the head, motor restlessness, slow or rapid pulse, and arrhythmia, the progression of eye disorders, strengthening of nystagmus. Often manifest vegetative disorders, increased and some difficulty in breathing, increased pyramid disorders; sometimes tonic seizures in the extremities. Respiratory failure is progressing or if it suddenly stops, often with satisfactory pulse. Stem symptoms are one of the most important components of occlusive attack.
The syndrome of increased intracranial pressure, due to ventricular hydrocephalus, manifested headaches, often paroxysmal character, fickle supratentorial cortical disorders (exhaustion, human consciousness varying degrees in the form of stunning, sometimes light, sound and olfactory hallucinations), congestive nipples optic nerves, secondary hypertension-hydrocephalic changes in the bones of the cranial vault and the Turkish saddle.
In cases where there are difficulties in diagnosis, particularly if necessary differentiation between supra - and subtentorial tumor, the most important additional method of research is pneumography using methods of ventrikulografii (see) or electroencephalography (see). Vertebral angiography of the brain in some cases through the introduction of a contrast medium into the vertebral artery precise localization of tumors of the brain vascular Genesis (angioretikulez).
In almost all cases, when there is a picture of occlusion at the level of the posterior cranial fossa and there are grounds to believe that it depends on the tumor cerebellum shown surgery. Even if the patient's condition is good, with clearly expressed symptoms of the cerebellum operation cannot be postponed for a long time, because the threat can occur suddenly, and vision often catastrophically leading to blindness. At occurrence threatening occlusive attack emergency surgical measures should be taken even before sharply expressed respiratory disorders. In these cases it is artificial respiration and urgent ventricular puncture; usually after removal of cerebrospinal fluid from the ventricular system disappear symptoms sharply increased intracranial pressure and stem compression, and the patient's condition quickly becomes satisfactory. After this in the next few hours must be made radical surgery. However, after breathing stops immediately apply these measures will often make it possible to treat and cure the patient.
The aim should be to completely remove the tumor, and at impossibility to make partial removal or decompression of the posterior cranial fossa, as even decompression reduces the compression of the trunk and improves circulation of the liquor. After partial removal of benign tumors is usually within a few years tumor growth resumes and there are indications for repeated operations. After uninstalling the Protocol shows radiotherapy, not prevent, however, further tumor growth and metastasis by liquor spaces. Yet the duration of life of the operated patients exceeds lifetime cooperative; the operated patients in the subsequent radiotherapy live usually from 2 to 5 years.