Overview

There are many different types of brain tumors. Brain tumors can be broadly classified as either primary or secondary. Primary brain tumors originate from within the brain itself. Secondary tumors spread to the brain from other parts of the body‰ÛÓmost commonly the lung, breast, or kidney. Brain tumors can be benign or malignant.

Presentation

Patients with brain tumors can present with a variety of symptoms and signs depending on the location of the tumor. Common presenting symptoms include headache, confusion, difficulty with memory, and seizures. If the tumor is near eloquent areas of the brain, patients can also present with motor weakness in the face, arm, or leg, or with difficulty with speech. Nausea and vomiting may also be a presenting symptom.

Workup

Depending on the severity of the symptoms, most patients will first be seen by their primary care physician or present to the emergency department. Work up will include a complete history and physical examination. Additional diagnostic information will usually be obtained with either an MRI of the brain or a head CT. At that point, patients will be referred to see a neurosurgeon.

Treatment

Treatment of most brain tumors will usually include surgery for removal of the tumor. Surgery also provides the benefit of obtaining tissue for the pathologist in order to determine the exact type of tumor and to help guide additional treatment if needed. Surgery can be made safer by utilizing computer navigational guidance, use of an intraoperative MRI, and tumor removal with an intraoperative microscope. Depending on the type of brain tumor, additional treatment may include chemotherapy or radiation therapy after surgery.

Common Brain Tumors

Meningiomas are slow growing, usually benign tumors. They arise from the meninges, or covering around the brain. Small tumors are sometimes found incidentally and can be followed with serial imaging over time. Larger tumors, those that are symptomatic, or those that have shown progressive growth are typically treated with surgery. Most meningiomas can be cured with surgery if completely removed.
Gliomas are the most common type of primary brain tumor. They arise from glial cells, or the supporting cells in the brain. Gliomas are graded one through four. Grade 1 tumors are called pilocytic astrocytomas and are most common in the pediatric population and are located in the cerebellum. These tumors are benign and can often be cured with surgery. Grade 2 tumors are infiltrating gliomas and can be classified by cell type as either astrocytomas or oligodendrogliomas. Grade 3 tumors are most commonly anaplastic astrocytomas. Grade 4 tumors are called glioblastomas. Grade 3 and grade 4 tumors are malignant and treatment involves surgical resection followed by chemotherapy and radiation therapy.
Metastatic tumors are malignant brain tumors that spread to the brain from other parts of the body. The most common sites include lung, breast, and kidney. Solitary metastatic brain tumors are often treated with surgical resection. Multiple metastatic brain tumors are typically treated with radiation therapy. Treatment may also include stereotactic radiosurgery.