Clinical manifestations
Glioblastoma is slow-growing and has a long course, averaging two years from the onset of symptoms to the time of consultation, while malignant tumors are fast-growing and have a short course, mostly within three months from the onset of symptoms to the time of consultation, with 70-80% within six months.
1.Astrocytoma
(1) General symptoms include increased intracranial pressure, headache, vomiting, optic nerve papillary edema, visual field changes, epilepsy, diplopia, cranial enlargement (in children) and changes in vital signs.
(2) Local symptoms vary according to the location of tumor growth.
(1) Cerebral hemispheric astrocytoma: about 1/3 of patients have epilepsy as the first symptom and about 60% of patients have epilepsy.
(2) Cerebellar astrocytoma: ataxia of the affected limb, clumsy movement, unstable holding, low muscle tone and tendon reflex, etc.
(③) Thalamic astrocytoma: light paralysis, sensory disorders and hemiplegia, ataxia and choreiform movements of the affected limb, mental disorders, endocrine disorders, ipsilateral blindness, supraoptic disorders and hearing disorders.
(4) Optic nerve astrocytoma: The main manifestations are visual impairment and abnormal eye position.
⑤ Third ventricular astrocytoma: Patients with obstructive hydrocephalus often present with severe episodic headache, sudden loss of consciousness, mental disorders, and memory loss.
(6) Brainstem astrocytoma: central tumors often show eye movement disorders, pontine tumors mostly show eye abduction limitation, facial nerve and trigeminal nerve involvement, medullary tumors often show swallowing disorders and changes in vital signs.
2.Glioblastoma
The tumor is highly malignant with fast growth and short course, most of them are within 3 months from the appearance of symptoms to the consultation. 33% of the patients have seizures, 20% of them have psychiatric symptoms such as apathy, dementia, mental retardation, etc. Different degrees of hemiplegia, hemianesthesia, aphasia and hemianopia may occur.
Oligodendroglioma and mesenchymal (malignant) oligodendroglioma: epilepsy is often the first symptom, psychiatric symptoms are mainly emotional abnormalities and dementia, invasion of motor and sensory areas may produce hemiparesis, hemianesthesia and aphasia, etc. High cranial pressure symptoms appear later.
3.Medulloblastoma
(1) The tumor grows rapidly and the symptoms of high cranial pressure are obvious.
(2) The damage of cerebellar function is manifested as staggering gait and unstable walking.
(3) Diplopia, facial palsy, enlarged head (in children), choking and coughing, etc.
(4) Tumor metastasis is an important feature of medulloblastoma.
4.Ventricular meningioma
(1) Symptoms of increased intracranial pressure.
(2) Brainstem compression symptoms such as vomiting, choking cough, hoarseness, dyspnea, etc., cerebellar symptoms (unsteady walking, nystagmus, etc.) and hemiparesis, supraocular dyskinesia, etc.
(3) The recurrence rate after surgery is 100%, and intravertebral metastasis is prone to occur.
Diagnosis
Glioma is the most common intracranial tumor. In addition to the commonality of clinical manifestations, different types and locations of tumors have their own symptoms and signs; coupled with the current number of imaging measures, CT/MR multi-angle and multi-parameter comparison, especially MR spectral analysis and other more specific studies, the diagnosis of glioma is not difficult. However, it should be differentiated from non-specific limited encephalitis, demyelination, early cerebral infarction, and certain intracerebral parasites.
Treatment
At present, the treatment of glioma at home and abroad is generally surgery, radiotherapy, chemotherapy, X-knife, γ-knife, etc.
1.Surgical treatment
Based on the fact that the growth of glioma is infiltrative and has no obvious boundary with normal brain tissue, and most of them are not limited to one lobe of the brain, and they destroy the brain tissue in a finger-like manner outside the tumor, it is theoretically impossible to remove them completely, and some tumors growing in important parts of the brain stem are not operable at all, so the treatment purpose of surgery can only be limited to the following five aspects
(1) To clarify the pathological diagnosis.
(2) To reduce the volume of tumor and decrease the number of tumor cells.
(3) To improve symptoms and relieve high cranial pressure.
(4) To prolong life and create time for other subsequent comprehensive treatment.
(5) To obtain tumor cell kinetic information to provide the basis for finding effective treatment.
2.Radiotherapy
Radiotherapy is the routine treatment for almost all types of glioma, but the efficacy evaluation is different. Except for medulloblastoma, which is highly sensitive to radiotherapy, and ventricular meningioma, which is moderately sensitive, all other types are insensitive to radiotherapy, and it has been observed that radiotherapy has the same prognosis as non-radiotherapy patients. In addition, the effect of radiation-induced radionecrosis on brain function should not be underestimated. There are new radiotherapy measures such as 131I or 125I brachytherapy in the tumor (cavity), but the efficacy and the corresponding side effects are yet to be further explored.
3.X, Y knife for glioma
X-knife and γ-knife are in the category of radiation therapy, but the treatment scope is limited due to the location of the tumor, the size of the tumor (generally limited to less than 3 cm) and the sensitivity of the tumor to radiation, and at present, it is considered that glioma, especially malignant astrocytic grade III-IV or glioblastoma are not suitable for R-knife treatment.
4.Chemotherapy
In principle, it is used for malignant tumors, but the efficacy of chemotherapeutic drugs is not yet certain because they are limited to the blood-brain barrier and the toxic side effects of drugs, and temozolomide, BCNU, CCNU and VM-26 are commonly used, but the efficiency is not high. There are attempts of intratumoral (cavity) interstitial chemotherapy, transarterial selective regional perfusion chemotherapy to increase the local drug concentration of the tumor, etc. The effect still needs further verification.
5.Chinese medicine treatment
According to the physiological characteristics of brain tumor and the heterogeneity of development, heterogeneity and metastasis, the expert group adopts the combination of modern medicine and traditional Chinese medicine to promote the Chinese medicine to pass the blood-brain barrier, return the essence to the brain, directly enter the tumor to play the role of phagocytosis and elimination, improve the microcirculation in the brain, make the blood oxygen It improves the microcirculation of the brain, enhances blood oxygen metabolism, and softens and shrinks the lesions. It is suitable for patients who have not undergone surgery or have already undergone partial resection, recurrence after surgery, X-knife, γ-knife and after radiotherapy, especially for headache, nausea and vomiting, tinnitus, numbness of limbs, convulsions, mental disorder, unclear double vision and other symptoms caused by brain tumor.
Since the biological characteristics of glioma are obviously different from those of other tumors, the application of emerging molecular biology and gene therapy in glioma is still very far away with many unresolved issues.
At present, the treatment of glioma should pay attention to the following points: choosing the appropriate treatment plan and emphasizing the first precise strike; emphasizing the individualized treatment of patients; and actively and steadily exploring new technologies.