Tongue Carcinoma

PET, CT & FUSED PET CT

Tongue Carcinoma

About Tongue Base Cancer
Since these cancers are often diagnosed relatively late, physicians consider cancer of the tongue base to be a serious oropharyngeal cancer. Professionals identify the oropharynx as the region in the oral cavity behind the last molar. Studies demonstrate that individuals with a history of nicotine and alcohol usehave an increased occurrence of tongue base cancer. The condition usually develops from squamous cells on the exterior layer of tongue tissue. Once identified early, the condition is highly curable.
Diagnosis
To diagnose and stage tongue base cancer, physicians will acquire a thorough history and perform a complete head and neck examination and may remove a small sample of the cancer to send to the laboratory for analysis. Pathologists qualified in identifying oral conditions will examine the tissue under a microscope.
Patients may also need to have imaging studies performed to see how far the cancer has spread. These may include:
X-rays produce a one-dimensional view of the head and neck to assist the physician in locating abnormalities in the tongue and additional structures of the mouth.
CT scans create two-dimensional and three-dimensional images of the head and neck that may reveal whether cancer has invaded nearby lymph nodes or other organs.
MRI technology utilizes magnetic fields and radio waves to distinguish small abnormalities in the head and neck (three-dimensional views) and to conclude if cancer has spread to other organs.
PET scans use radioactive materials to recognize metabolically active tissues, such as cancer in the tongue, in lymph nodes and other organs of the body such as the lungs, liver or bones.
Symptoms
The following symptoms commonly occur with tongue base cancer:
A persistent (lasting six weeks or more) sore or ulcer on the back of the tongue
Ongoing pain in the mouth
Difficulty breathing
Difficulty swallowing
Foul breath
Pain with swallowing
Sore throat
Severe pain in one ear
Lumps in the neck
Difficulty speaking
Difficulty chewing and swallowing
Weakness of the tongue
Treatment
Treatment for tongue base cancer depends on the patient's general physical condition and the extent of the disease. Most commonly the cancer develops from squamous cells on the surface of the tongue. Rarely, pathologists conclude the condition to occur from the insignificant salivary glands or lymph tissue.
For many stages of squamous cell carcinoma, or other forms of tongue base cancer that originate deeper in the tongue, the risks of surgery may outweigh the benefits. In these cases radiation therapy or chemoradiation therapy may be considered. The exception is if the cancer can be treated with transoral laser microsurgery.
Surgery
Early cancers of the tongue base can often be removed using a laser or cautery instrument working directly through the mouth. The hospitalization is brief and function of the tongue is exceptional. For most larger tongue base cancers, new surgical methods to the tongue base allow removal of any involved lymph nodes and the tongue cancer through a single neck incision. For extremely large tumors for which surgical removal would considerably compromise speech and swallowing, radiation and chemotherapy are used. In most cases of apparent spread to the neck lymph nodes after chemoradiation, surgical removal of the involved lymph nodes is still needed. This procedure is called a neck dissection and physicians use the newest surgical techniques to protect the appearance and function of the neck and shoulder.
Radiation Therapy
Radiation therapy utilizes high-energy X-rays, electron beams, or radioactive isotopes to destroy cancer cells. Radiation oncologists modify each treatment to protect nearby normal tissue.
IMRT uses digital diagnostic imaging, computers, and specialized software to conform many small radiation beams to the shape of the tumor. This produces exact dosage distributions that protect nearby normal tissue. IMRT helps to reduce the loss of function of the tongue and normal adjacent structures such as the salivary glands.
Patients with tongue base cancer can also receive brachytherapy. Brachytherapy is a form of radiotherapy in which specialists position the source of irradiation near the tumor. In the case of tongue base cancer, radioactive material may be located directly into body tissue by hollow needles (interstitial). Brachytherapy may be used in addition to external beam radiation therapy.
Chemotherapy
In the case of tongue base cancer, oncologists administer chemotherapy for large cancers and/or once the cancer has spread to many lymph nodes or other organs in the body. Chemotherapy uses drugs to destroy cancer cells. Medical oncologists administer chemotherapy orally or through the patient's veins. For tongue base cancer, physicians normally use chemotherapy in combination with radiation therapy. If the cancer has metastasized (spread) to distant parts of the body, chemotherapy alone might be considered to help manage the cancer.
Rehabilitation
Care providers specializing in speech therapy, swallowing therapy, dietetics, physical therapy, and occupational therapy help patients with any rehabilitation needed after radiation therapy. The Nicotine Dependence Center can help patients who want to terminate tobacco use.

Information from mayoclinic.com and medscape radiology

Cerebral Aneurysm

Cerebral Aneurysm
A cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak spot on a blood vessel in the brain that bulges out and fills with blood that can put pressure on a nerve or the surrounding brain tissue. It may also leak or rupture, spilling blood into the nearby tissue (called a hemorrhage). Some cerebral aneurysms, mostly those that are very small, do not bleed or cause other problems. Cerebral aneurysms can occur anywhere in the brain, but most are located along a loop of arteries that run between the base of the brain and the base of the skull.
Diagnosis
Diagnosis of Ruptured Cerebral Aneurysm
A ruptured cerebral aneurysm leads to bleeding within the brain, causing sudden onset of very severe headaches, loss of consciousness, stiff neck or seizures, serious complications and death. These tests are the main tools used to diagnose a ruptured cerebral aneurysm:
Computed tomography (CT) An X-ray procedure that produces detailed images of the brain in cross-sectional slices. CT scans are very sensitive in detecting blood in the subarachnoid space from a ruptured aneurysm. The scan shows the distribution of blood in the brain, providing significant evidence regarding the aneurysm's location.
Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to create detailed images of the brain and other body structures. Magnetic resonance angiography (MRA) produces more detailed images of blood vessels. These painless, noninvasive procedures can demonstrate the size and shape of an unruptured aneurysm and can identify bleeding in the brain.
A cerebrospinal fluid examination (CSF) In some cases, the physician may consider a subarachnoid hemorrhage, but the hemorrhage is not discovered on a CT scan. The CSF can help verify a ruptured aneurysm by identifying blood in the cerebrospinal fluid. A needle is introduced into the lower back to remove a small amount of spinal fluid.
Diagnosis of Unruptured Aneurysm
Unruptured aneurysm patients experience headaches or localized abnormalities in brain function. Physicians use magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) to diagnosis this condition.
If an aneurysm or subarachnoid hemorrhage is found, the physician may perform a diagnostic test known as a cerebral angiogram to localize the aneurysm. A catheter (thin tube) is placed into an artery in the leg and guided through the bloodstream to the arteries in the neck that lead to the brain. Dye is injected into the arteries as X-rays are taken. These images provide a map of the arteries. MRI, MRA, and CTA scanning also can be used to find an aneurysm, but a cerebral angiogram usually provides more definitive information.
Screening for cerebral aneurysms using MRI, MRA or CTA is recommended for people at high risk, including those with a considerable family history of cerebral aneurysms and those with a disease called autosomal dominant polycystic kidney disease.
Causes
Usually, no definite cause of the aneurysm is established. Though, factors that increase the risk of cerebral saccular aneurysms include:
Genetics or an inherited condition
High blood pressure or hardening of the arteries in the brain
Cigarette smoking
A blood clot that goes to the brain
Some types of infection
Injury or trauma to the head
Habitual cocaine use
Treatment
The goal of treatment is to prevent future hemorrhage. There are two major ways this can be accomplished.
Surgery
The most common treatment for cerebral aneurysms is open surgery under general anesthesia. The neurosurgeon makes an incision in the scalp, makes a window in the skull, locates the aneurysm, and places a metal clip across the neck of the aneurysm to inhibit rupture. Advanced microsurgical techniques have significantly reduced the risks of surgery; yet, the outcome is related with the aneurysm's size, location, and shape.
Endovascular Therapy
In endovascular therapy, a neuroradiologist passes a catheter through an artery and places detachable platinum coils in the aneurysm. These devices prevent bleeding and protect against subarachnoid hemorrhage. Gaining recognition in the treatment of both ruptured and unruptured aneurysms, endovascular therapy offers a less invasive option to surgery for some patients with difficult-to-reach aneurysms.
The procedure is typically done under general anesthesia to keep the head still during placement of the coils.
Monitoring
Some aneurysms have such a low risk of rupture that periodic monitoring offers a preferable method to treatment.
According to a recent study at Mayo Clinic, patients with rather small aneurysms — under ¼ inch in diameter — located in the front portion of the brain had the lowest risk of subarachnoid hemorrhage. Patients with aneurysms ½ inch or more in diameter in the back part of the brain had the highest risk. Patients with a history of subarachnoid hemorrhage from a previous aneurysm also had a higher risk of subarachnoid hemorrhage. Rupture risk also increased significantly in patient’s age 50 and older, with the highest risk in patients age 60 and above. A history of rupture due to another aneurysm increased the risk of rupture as well.
As a result of this study, many neurologists and neurosurgeons now recommend a more conservative method instead of surgery for patients without a history of subarachnoid hemorrhage who have small aneurysms located in the front portion of the brain.

Information from: mayoclinic.org & HealthLink.com

Angiofibroma

Juvenile Angiofibroma

Juvenile angiofibroma is a benign nasal tumor of the back of the nose or upper throat
Juvenile angiofibroma is somewhat unusual. It characteristically is found in teenage boys. The tumor includes numerous blood vessels, is locally invasive, and can cause bone damage.
Symptoms:
Frequent nosebleeds
Stuffy nose
Difficulty breathing through the nose
Nasal discharge, usually bloody
Hearing loss
Prolonged bleeding
Easy bruising

Exams and Tests:
The doctor may see the angiofibroma when examining the upper throat.
Tests that may be done include:
X-ray or a CT scan of the head
Nasal mucosal biopsy

Treatment :
Treatment is necessary if the angiofibroma is growing larger, blocking the airway, or causing recurring nosebleeds. In some cases, no treatment is necessary.
Surgery may be needed to remove the tumor. Removal is frequently complicated because the tumor is not enclosed and may have spread to other areas.
A procedure called embolization may be done to prevent the tumor from bleeding. The procedure may correct the nosebleeds by itself, or it may be followed by surgery to remove the tumor.

Prognosis:
Although not cancerous, angiofibromas may continue to develop, even after surgery. Several may vanish by themselves.

Possible Complications:
Spread of the tumor to the nose, the sinuses, and other structures
Anemia
Pressure on the brain (rare)

Prevention:
There is no known way to avoid this condition.

References provided by VeriMed Healthcare Network.

Optic Nerve Glioma

Optic Nerve Glioma

Optic nerve glioma is the most common primary neoplasm of the optic nerve causing decreased visual sharpness in the affected eye. Benign optic glioma occurs most often in children, more females with an average age of five years. Another form, aggressive glioma, which is unusual is most common in adults, more males with a median age of fifty-two years; it is often terminal, even with treatment. .
From 10-38% of children with optic nerve glioma is also known to have neurofibromatosis type 1 (NF-1) or, in some cases, the more recently described hybrid phakomatosis. In 66% of NF-1 patients with optic nerve glioma, the growth involves the intraorbital optic nerve. In 10-20%, the tumor is confined to the orbit, with the remainder of these patients showing involvement of the intracranial compartment.
Optic nerve gliomas represent 4% of orbital tumors, 4% of intracranial gliomas, and 2% of intracranial tumors. They also include two thirds of all primary optic nerve tumors.
Benign optic glioma develops gradually, if at all. Yet, some lesions can grow, causing visual impairment, so follow-up is recommended.
Twenty percent of optic gliomas that extend to the optic chiasm or outside, into the optic radiations, exhibit a more aggressive path.
In the absence of NF-1, the optic chiasm is most usually involved, as is, less often, the intraorbital optic nerve. Optic nerve glioma may involve different sections of the retrobulbar visual pathway, including the optic nerve, chiasm, tracts, and radiations. Malignant lesions can occupy the hypothalamus, basal ganglia, and internal capsule directly, or they may extend to the leptomeninges or subpial surfaces.
In most young patients with optic glioma, the symptom is painless proptosis. Optic atrophy is common, as is reduced visual sharpness, (which may be a late symptom). A large lesion may compress the optic chiasm, causing nystagmus. Hypothalamic symptoms, such as changes in appetite or sleep, also may occur. Massive lesions may compress the third ventricle, resulting in obstructive hydrocephalus accompanied by headache, nausea, and vomiting.
In adult patients, bilateral vision loss is a common early finding because most lesions involve the optic chiasm.
Contrasted computed tomography (CT) scanning can be used to differentiate confined involvement of optic nerve glioma within the orbit and the presence of an intraconal mass. CT scanning can distinguish a faint attrition or growth of the optic canal. In addition, fine calcification, which may help to identify a lesion as a meningioma rather than a glioma, is visualized best through CT scanning.
Findings:
In children, unenhanced CT scans normally reveal an evident, diffuse growth of the optic nerve, with typical twisting. The enlargement may be tubular, fusiform, or excrescent.
Areas of lucency may result from mucinous or cystic changes.
Approximately 50% of the lesions reveal enhancement; this characteristic is more common with intracranial (especially retrochiasmatic) extension.
Calcifications are unusual.
Improper examination techniques, including failure to administer contrast or obtain thin sections, can lead to a false-negative diagnosis.
Magnetic Resonance Imaging (MRI), however, is the preferred method for definitive evaluation of optic nerve glioma. Both the intraorbital lesion and its intracranial degree can be effectively differentiated through MRI. When evaluating the orbit, gadolinium-enhanced T1-weighted images with fat saturation can define the degree of aggressive glioma. Intracranially, MRI allows better evaluation of the optic nerve, chiasm, tracts, geniculate body, and optic radiations and shows even slight lesions of the optic nerve than does CT.
Findings:
On T1-weighted images, optic nerve gliomas are usually isointense to the cortex and hypointense to white matter.
Invariably, the lesions are hypointense to orbital fat.
On T2-weighted images, lesions show a varied appearance that is isointense to hyperintense relative to white matter and the cortex.
Following contrast administration, intense enhancement is common.
A diagnosis of NF-1 may be supported by several findings including the following:
Bilateral optic nerve gliomas.
Spongiform changes (hyperintensity on T2-weighted images) in the cerebellum, brain stem, basal ganglia, thalamus, periventricular white matter, and corpus callosum
Adult lesions may involve the orbital, intracanalicular, or prechiasmal portions of the optic nerve, resulting in enlargement; they may exhibit retrochiasmatic extension as well).
Usually, the lesions are hypointense to isointense relative to the optic nerve on T1-weighted images and are hyperintense to it on T2-weighted images. Enhancement is homogeneous and intense.
Patients without NF-1 show cystic components more commonly at T2 -weighted imaging.
The diagnosis may be made with a high level of confidence when the lesion involves the optic chiasm and retrochiasmatic optic pathway.
When limited entirely to the orbit, the lesion may imitate optic neuritis, pseudotumor, lymphoma, or optic nerve meningioma. Characteristically, meningioma, the main differential diagnostic consideration, is distinguished by the "tram-track" sign, with enhancement of the periphery of the nerve–optic sheath unit. Conversely, enhancement in optic nerve glioma is more uniform. Isolated growth of the optic nerve sheath also may present diagnostic complexity; however, this enlargement can generally be distinguished by its signal characteristics, which follow fluid signal on all MRI pulse sequences.
In most occasions, the diagnosis can be made with greater assurance using MRI than it can with CT scanning.
A false-positive diagnosis can occur as an effect of unilateral optic nerve enhancement or other unilateral disorders, such as optic meningioma, vascular lesions, neuritis, pseudotumor, lymphoma, and sarcoidosis. In addition, subtle nerve enhancement occasionally may develop in normal individuals.
Improper examination procedures, including failure to administer contrast, use fat saturation, or obtain thin sections, can result in a false-negative diagnosis.
Local surgical therapy for large lesions may cause significant morbidity, including hypothalamic dysfunction. Stereotactic radiation or gamma-knife therapy also can produce complications, including decreased visual perception, radiation-induced optic neuritis, and ophthalmic artery vasculopathy.
Despite aggressive radiation, chemotherapeutic, or surgical treatment, aggressive glioma is an almost uniformly fatal disease.
Information By: Emory University School of Medicine.org

Pituitary Gland Tumors

Pituitary Gland Tumors

The pituitary gland is a tiny bean -shaped gland located at the base of your brain, posterior to your nose and between your ears. Its hormones help regulate important functions, such as growth, blood pressure and reproduction. Sometimes pituitary tumors can generate excess amounts of hormone and sometimes, pituitary tumors can limit the pituitary gland, causing it to produce lower levels of hormones (hypopituitarism), which usually originates in the anterior pituitary (adenohypohysis). A tumor can also compress the optic nerve — the nerve that transmits visual information from the eye. Most pituitary tumors are benign, nonspreading (adenomas). The cause of pituitary tumors remains unknown.

Signs and symptoms

Pituitary tumors that produce hormones are called functioning tumors and tumors that don't produce hormones are known as nonfunctioning pituitary tumors. Various types of functioning tumors can grow in your pituitary gland, each causing particular signs, and symptoms:

Adrenocorticotropic hormone-producing tumors. These pituitary tumors create the hormone adrenocorticotropin, which stimulates your adrenal glands to produce the hormone cortisol. When your adrenal glands make too much cortisol, a condition called Cushing's syndrome takes place. Signs and symptoms of Cushing's syndrome may consist of weight gain around your midsection and upper back, inflated facial roundness, a typical bulge on the upper part of your back, high blood pressure, muscle weakness and thinning of your skin.

Growth hormone-producing tumors. These tumors produce extra growth hormone (acromegaly), which may include coarsened facial features, enlarged hands and feet, high blood pressure and heart problems. Accelerated and extreme growth (gigantism) may occur in children.

Prolactin-producing tumors. Overproduction of prolactin (hyperprolactinemia) from a pituitary tumor (prolactinoma) can cause a reduction in normal levels of sex hormones — estrogen in women and testosterone in men.

In women, prolactinoma may cause irregular menstrual periods (oligomenorrhea), lack of menstrual periods (amenorrhea) and milky discharge from the breasts (galactorrhea).
In men, a prolactin-producing tumor may cause male hypogonadism, such as enlarged breasts (gynecomastia), erectile dysfunction (ED) or impotence, infertility, decrease in body hair, and loss of interest in sexual activity.

Thyroid-stimulating hormone-producing tumors. When a pituitary tumor overproduces thyroid-stimulating hormone (thyroxin). This is an unusual cause of hyperthyroidism, or overactive thyroid disease. Hyperthyroidism can increase the body's metabolism, causing sudden weight loss, a rapid or irregular heartbeat, and nervousness or irritability.

Functioning and nonfunctioning pituitary tumors may cause other signs and symptoms, including:
Headache
Vision changes, such as decreased peripheral vision or double vision
Seizures
Clear, watery nasal drainage
Hair loss
Cold intolerance
Constipation
Irritability
Weakness
Fatigue
Nausea
Vomiting
Low blood pressure

Risk factors
Even though pituitary tumors can happen at any age, they're most likely to occur in older people. People with a family history of multiple endocrine neoplasia type 1 (MEN 1) have an increased risk of pituitary tumors. In MEN 1, multiple tumors occur in different glands of the endocrine system.

Screening and diagnosis
Blood tests detect the overproduction or lack of hormones as a result of a pituitary tumor.
Brain imaging. A computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the brain can identify a pituitary tumor.

Vision testing. These tests can conclude if development of a pituitary tumor has harmed the sight or peripheral vision.
Bone imaging. In children, an X-ray of the hand and wrist can determine whether bone growth is normal.

Treatment
Treatment for a pituitary tumor relies on the kind of tumor, its size, and how far it has spread into the brain. The age and general health also need to be considerations. Because pituitary tumors can cause severe problems by putting pressure on the brain, treatment often is essential. Early detection of pituitary tumors is important to effective treatment.
Doctors usually use surgery, radiation therapy, and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

Surgery

The most common treatment for pituitary tumors is surgery. Surgery for a pituitary tumor normally is necessary if the tumor is pressing on an optic nerve, which can cause loss of vision. The effectiveness of surgery depends on the tumor type, its location, its size, and whether the tumor has spread. The two most important surgical procedures for treating pituitary tumors are:
Transsphenoidal hypophysectomy. With this method, a doctor usually can reach and remove the tumor through the nose and sinuses without an external incision, but very large tumors may be complicated to remove with this process, particularly if a tumor has occupied close to nerves or brain tissue.
Transcranial hypophysectomy. Through this procedure, the larger more difficult tumor is removed through the upper part of the skull by an incision in the scalp.

Radiation therapy

Radiation therapy uses high-energy X-rays to destroy tumors. It can be used after surgery or as main treatment only if surgery isn't an alternative. Radiation therapy can be helpful if a tumor reoccurs after surgery and causes signs and symptoms that medications don't ease.

Types of radiation therapy include:
External beam radiation. This kind of radiation therapy delivers small amounts of radiation over a period of time. As this therapy is often efficient, it may take years to completely control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, mainly near the pituitary gland.
Gamma-knife radiosurgery. This type of radiation therapy focuses radiation beams exactly on the tumor without an incision. With gamma-knife radiosurgery, a small amount of radiation affects the healthy tissue surrounding the tumor, reducing the harm to normal tissue, but this therapy can’t be used if the tumor is close to an optic nerve or another sensitive structure.

Drug TherapyTreatment with medications (drug therapy) may help to stop excess hormone secretion and sometimes decrease certain types of pituitary tumors:
Prolactin-producing tumors (prolactinomas). The drugs bromocriptine (Parlodel) and cabergoline (Dostinex) can treat these types of tumors by reducing prolactin secretion and often decreasing the size of the tumor. These medications are often so successful in treating these kinds of tumors that surgery isn't necessary.
Growth hormone-producing tumors. Two types of medications are used for these kinds of pituitary tumors. Drugs known as somatostatin analogs (Sandostatin, others) cause a reduction in growth hormone production and may decrease the size of the tumor. Pegvisomant (Somavert) obstructs the result of excess growth hormone on the body. These drugs are helpful if surgery has been ineffective in regulating growth hormone production.
If a pituitary tumor has resulted in reduced hormone production, hormonal replacement may be necessary to sustain normal hormone levels.

Observation
In observation, regular follow-up tests are needed to monitor for evidence of progression of the pituitary tumor and medications, radiation therapy, and surgery aren't used. Observation may be the option if the tumor isn't causing any signs or symptoms.
Observation may be mainly appropriate due to age and/or poor health. Numerous people with pituitary tumors function normally without treatment and without the tumor causing other problems.

Pituitary Tumor Information from : Eighth Edition Profession Guide to Diseases by: Lippincott Williams and Wilkins and from : mayoclinic.org

Acoustic Neuroma

Acoustic neuroma

Acoustic neuroma is a noncancerous (benign) tumor that extends on a section of the eighth cranial nerve, (which runs from your brain to your inner ear) and controls equilibrium and hearing. Also known as vestibular schwannoma, acoustic neuroma is one of the most common types of brain tumors. Though, these tumors are unusual, occurring in about one person in 100,000.

Signs and symptoms

The signs and symptoms of acoustic neuroma are produced from the tumor pressing on the hearing segment of the eighth nerve. Most acoustic neuromas increase slowly, over many years to become large enough to cause signs and symptoms. Most likely observed in people between ages 30 and 60, acoustic neuromas are uncommon in children, and a higher incidence of occurring in women. In unusual cases, an acoustic neuroma may develop large enough (up to 6 centimeters) to compress on the brainstem and be critical

For some people, the tumor remains so tiny ( less than 1.5 centimeters) it never causes problems. They may need no treatment other than regular monitoring by their doctor .In unusual cases, an acoustic neuroma may develop large enough (up to 6 centimeters) to compress on the brainstem and be critical. Also, large tumors can stop cerebrospinal fluid flow which can cause increased fluid pressure in skull (hydrocephalus). If they need treatment, the choices include radiosurgery and surgical removal.

Signs and symptoms include:

* Permanent Hearing loss, typically gradual — although in some cases sudden — and occurring on only one side or more prominent on one side
* Ringing (tinnitus) in the affected ear
* Dizziness (vertigo)
* Loss of equilibrium
* Facial numbness and tingling
* Headaches
* Mental Confusion

The cause of acoustic neuromas is unknown. But, the tumors, in unusual cases, are a sign of neurofibromatosis 2, a genetic disorder that involves the development of tumors on the vestibulocochlear nerve (bilaterally).

Diagnosis

Because signs and symptoms of acoustic neuroma are likely to develop slowly and because hearing loss, tinnitus and dizziness can be signs of other middle and inner ear problems, it may be complicated for the doctor to identify the tumor in its beginning stage. Acoustic neuromas often are found during testing for other conditions.

* Scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans of the head can provide images that confirm the presence of an acoustic neuroma.
* Hearing test (audiometry). During this test performed by a hearing specialist (audiologist), the patient wears earphones and hears sounds directed to one ear at a time. The audiologist presents a range of sounds of different tones and asks them to specify each time they hear the sound. Each tone is repeated at soft levels to find out when they can barely hear. The audiologist also will present various words to determine their hearing ability.
* Electronystagmography (ENG). This test assesses balance (vestibular) function by identifying abnormal rhythmic eye movement (nystagmus) often present with inner ear conditions. The test measures involuntary eye movements while stressing balance in various ways.
* Brainstem auditory evoked response (BAER). This test tests hearing and neurological functions. Electrodes on the scalp and earlobes capture the brain's responses to clicking sounds heard through earphones and record the responses on a graph.

Treatment

There are three choices for managing an acoustic neuroma: observation to determine whether it's growing and how fast, radiation and surgical removal.

Monitoring
If it is a small acoustic neuroma that isn't growing or is growing slowly and causes few or no signs or symptoms, the doctor may decide to monitor it, especially if in an older adult or otherwise not a good candidate for treatment.

The doctor may suggest regular imaging and hearing tests to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive hearing loss or other difficulties, treatment may be necessary.

Radiation
Several forms of radiation are used to treat acoustic neuromas. One, a procedure called gamma-knife radiosurgery, enables doctors to deliver radiation accurately to a tumor without making an incision. The doctor attaches a lightweight head frame to the numbed scalp. Using imaging scans, the doctor localizes the tumor and then plots where to apply the radiation beams. This procedure often is performed under local anesthesia.

The purpose of radiosurgery is to stop the growth of a small tumor. It also may be used for residual tumors, portions of a tumor that traditional brain surgery can't remove without damaging brain tissue.

It may take weeks, months, or years before the effects of radiosurgery become evident. The doctor will monitor the progress with follow-up imaging studies.

Immediate side effects of gamma-knife procedures are minimal and may include nausea, neck stiffness, and pain where the frame was attached to the scalp. Long-term risks may include facial paralysis and hearing loss.

Surgical removal
The purpose of surgery is to remove the tumor and maintain the facial nerve to prevent facial paralysis and preserve hearing. Performed under general anesthesia, this type of surgery involves removing the tumor through an incision in the skull. Recovery may take six to 12 weeks.

Risks include infection, bleeding, and reaction to the anesthesia. As with radiosurgery, there is a risk of hearing loss and facial paralysis. The patient is not likely to regain hearing lost as a result of the acoustic neuroma.

Acoustic Neuroma Information from: Eight Edition Profession Guide To Diseases by: Lippincott Williams and Wilkins and from: mayoclinic.org

Meningiomas

Meningiomas are usually slow-growing tumors that develop from the meninges, the protective layer of the brain and spinal cord. Meningomas account for about 20 percent of primary brain tumors and are most likely found in middle-aged or elderly adults, more commonly in women than men. Although they are almost always benign, meningiomas can be difficult to remove completely and can recur.


Diagnosing a brain tumor usually involves several steps. The physician may perform a neurological exam, computerized tomography (CT), magnetic resonance imaging (MRI) scan, angiogram and head and skull x-rays.


A meningioma can cause a diversity of symptoms because it can directly press on brain tissue, damaging or destroying areas responsible for sight, movement, balance, speech, hearing, memory or behavior.


Brain tumor symptoms initially may be vague and come-and-go, delaying diagnosis. Other diseases can cause similar symptoms.


Symptoms can include:
Headaches
Problems with memory, concentration and/or forming words
Personality changes
Vision problems (blurred or double vision, loss of peripheral vision)
Gradual loss of sensation or movement in an arm or leg
Loss of balance or hearing
Difficulty swallowing
Drowsiness
Seizures
Decreased sense of smell


Initial Treatment Steps
Steroid medications may be needed to reduce swelling and inflammation of brain tissue.
Anticonvulsant medications may be prescribed to help control seizures.
A shunt may be inserted if the tumor has resulted in a buildup of fluid in the brain (hydrocephalus). The tube allows excess fluid from the brain to drain into the abdominal cavity where it is reabsorbed.


TREATMENT
Surgery is usually the first approach. Because meningiomas tend to have well-defined edges and do not invade the brain, complete removal is sometimes possible. The standard treatment is to remove the tumor, the portion of the lining of the brain or spinal cord to which it is attached and any bone involved.
Many of these tumors are at the base of the brain and are located near cranial nerves and blood vessels and surgery is more complicated because of the risk of damaging the nerves and blood vessels. Complete surgical removal is sometimes not possible.
Even with removal, meningiomas are not always cured, the recurrence rate varies from 10 to 20 percent (measured over 10 years). When the entire tumor is not removed, the recurrence rate is higher.


Computer-Assisted Surgery for Tumor Removal
Computer-assisted tumor removal (volumetric stereotactic resection) is a surgical method that uses computer-generated models of the tumor built from data obtained by computer imaging techniques. This allows the neurosurgeon to simulate the surgical procedure beforehand to reach a brain tumor using the least invasive route possible.


Radiation
Radiation uses high-energy X-rays to destroy meningioma cells and often is used to destroy any remaining tumor cells that could not be removed surgically.


Stereotactic Radiosurgery
The treatment precisely focuses radiation beams to the tumor. (Gamma Knife™ surgery )
This treatment shows a decreased incidence of cranial nerve damage following radiosurgery and an improved chance that the tumors will not recur.
The advantage of stereotactic radiosurgery is that surrounding, healthy tissue receives minimal radiation compared to the tumor.


Fractionated Stereotactic Radiosurgery (FSR)
FSR provides multiple smaller treatments to spare the normal tissues but destroy the meningioma.
For this procedure, the patient is fitted with a plastic mask that aids in positioning and locating the tumor during treatment. The treatment is given in several smaller units called "arcs." The number of treatments depends on the size and location of the meningioma.


External-Beam Radiation
This traditional form of radiation therapy delivers radiation from outside the body. The radiation usually involves treatments five days a week for a length of time determined by the type of tumor. External beam radiation is less precise, but allows a wider margin of tissue around the tumor to be treated.


Chemotherapy and Other Drug Therapy


Combination Treatments are also used.