Cerebellar Tumor: Symptoms, Diagnosis and Treatment

Tumor of the cerebellum is one of the varieties of neoplasms of the brain. The tumor of the cerebellum can be benign and malignant, the most diverse in histological structure. Even if the tumor is benign, due to its special location, it can represent immediate threat to the life of the patient due to the possibility of infringement of the structures of the brain with respiratory failure and blood circulation. Tumor of the cerebellum manifests itself as cerebral, distant and focal (cerebellar) symptoms. For the diagnosis of this pathology compulsory computed tomography (CT) or magnetic resonance imaging (MRI) of the brain is mandatory. Treatment of a tumor of the cerebellum is mainly operative. From this article you can learn about the main symptoms, methods of diagnosis and treatment of cerebellar tumors.

Classification and terminology

Among all neoplasms of the brain, the share of cerebellar tumors accounts for about 30%.

Like all tumors of the nervous system, tumors of the cerebellum can be primary (if their source are nerve cells or shells of the brain) and secondary (if they are tumor metastasis of another localization).

According to the histological structure, the tumors of the cerebellum are also very diverse (more than 100 species are known). However, the most common are the cerebellar gliomas (medulloblastomas and astrocytomas) and metastases of cancer.

Gliomas of the cerebellum account for more than 70% of all tumors of the posterior cranial fossa. In small children histologically, tumors are more often medulloblastomas, in middle-aged people - astrocytomas and angioretikulems. In mature and elderly age, the palm tree belongs to metastases of cancer and glioblastomas.

Tumors of the cerebellum can have relatively benign, slow growth, ranging from normal brain tissue (as it were in a capsule), but can infiltrate surrounding tissues, which in itself is less favorable.

Symptoms of a cerebellum tumor

All signs of a growing cerebellar tumor can be divided into three groups:

• cerebral (develop due to increased intracranial pressure);
• remote (occur at a distance, that is, not directly next to the tumor);
• focal (actually cerebellar).

Almost in all cases, these three groups of symptoms occur simultaneously with each other, just the severity of these or other signs varies. In many ways, this is determined by the direction of tumor growth and compression of several nearby structures.

The special location of the cerebellum in the cavity of the skull determines certain features of the clinical course of its tumors. A clinical situation is possible, when the first signs of a tumor are cerebral and even distant symptoms. This is due to the fact that the cerebellum is located above the IV ventricle and the brain stem. Therefore, sometimes the first symptoms of neoplasm of the cerebellum are signs of brainstem lesion and violation of the outflow of cerebrospinal fluid from the IV ventricle, and not the cerebellum itself. And the defeat of the cerebellum tissue is compensated for a while, and therefore, does not show itself anything.

General cerebral symptoms of a cerebellum tumor

They include:

• headache. It can be felt in the occipital region and even in the neck. It can be periodic or constant with periods of amplification. If intracranial pressure rises, the headache becomes diffuse, accompanied by a feeling of nausea and vomiting;
• nausea and vomiting, not associated with eating. These symptoms are associated with the irritation of specific centers in the brainstem. Appear more often in the morning. Also these signs may be the result of increased intracranial pressure;
• dizziness;
• congestive discs of the optic nerves. This change can be seen only with ophthalmologic examination. In the case of a cerebellar tumor (in comparison with brain tumors of another localization), stagnant discs of the optic nerves appear relatively early, even before the directly cerebellar symptoms. Most likely, this is due to the rather rapid compression of important venous outflow tracts in tumors of cerebellar localization.

Distant symptoms of the cerebellum tumor

In the case of a cerebellar tumor these symptoms are represented by the defeat of the cranial nerves (or rather, their compression). Cranial nerves, for the most part, emerge from the thickness of the brain tissue in the region of the brainstem. The growing tumor of the cerebellum compresses the nerve roots, which causes the appearance of various symptoms. It can be:

• pain and sensitivity disorders in one half of the face, difficulty with chewing (associated with compression of the trigeminal nerve);
• strabismus (affection of the distracting nerve);
• asymmetry of the face (defeat of the facial nerve);
• hearing impairment or ringing in the ears (VIII pair of cranial nerves);
• disturbance of the mobility of the tongue and associated with it some vagueness of speech;
• changes in taste sensitivity.

It should be noted that the defeat of the nerves of the bulbar group is less common than V-VIII pairs.

In addition to the symptoms from the side of the cranial nerves, the distant signs of a cerebellar tumor include the appearance of weakness or a change in sensitivity in one half of the body, epileptic seizures, an increase in muscle tone over the spastic type.

Focal symptoms (actually cerebellar)

These manifestations of the tumor process are associated with direct damage to the tissue of the cerebellum.

The cerebellum consists of several parts: the central part of the worm and the hemispheres (left and right) located on its sides. Depending on what part of the cerebellum the tumor is squeezing, there are various symptoms.

If the worm is affected, then the following symptoms appear: violation of standing and walking. A person swayed while walking and even standing, stumbles on level ground and falls. The walk resembles the movement of a drunkard, at the bends "brings" to the side. To stand still, he needs to spread his legs widely, to balance with the help of hands. As the tumor grows, the instability is manifested even in the sitting position.

If the tumor grows in the zone of one of the cerebellar hemispheres, then smoothness, accuracy and proportionality of movements on the side of the tumor (i.e., left or right) are violated. A person misses when trying to take an object, he does not get to perform the actions associated with the rapid contraction of the muscles-antagonists (flexors and extensors). On the side of the lesion, muscle tone decreases. Changing handwriting: the letters become large and uneven, as if zigzag (this is also associated with a violation of the correct contraction of the muscles of the hand). Speech disturbances are possible: it becomes intermittent, spasmodic, as it were chanting, divided into syllables. There is trembling in the limbs on the side of the tumor, which is strengthened towards the end of the movement.

As the tumor grows, the symptoms of the worm and hemisphere are gradually mixed, the process becomes two-sided.

In addition to the above signs, the patient may be diagnosed with nystagmus. It is the jerky vibrational involuntary movements of the eyeballs, especially when looking away.

The proximity of the cerebellum tumor to the IV ventricle causes a violation of the circulation of the cerebrospinal fluid. Develops internal hydrocephalus with headaches, attacks of vomiting and nausea. The overlap of the ventricles of the IV ventricle may be accompanied by the Bruns syndrome. This can occur with a sharp change in the position of the head (especially when tilted forward), in connection with which the tumor is displaced and overlaps the holes for circulation of the cerebrospinal fluid. The syndrome is manifested by a sharp headache, indomitable vomiting, marked dizziness, temporary loss of vision, confusion of consciousness. At the same time, there are violations of the heart and respiratory organs, which present a danger to life.

Another dangerous condition that can occur with a tumor of the cerebellum is the infringement of the brain tissue. The fact is that a growing tumor occupies a part of the space inside the skull, and this space is constant. The rest of the brain tissue simply has nowhere to go, and it "moves" in the direction of the nearby holes of the skull (in particular, the large occipital opening). Infringement is possible and in the tenderloin on the outline of the cerebellum (the latter is formed by the dura mater). Infringement of brain tissue is very dangerous for a person, because at that moment he risks losing his own life.

Diagnostics

For the diagnosis of a cerebellar tumor an important role is played by a thorough neurological examination, an ophthalmologist's consultation with a mandatory examination of the fundus. The most informative for diagnostics are ray methods of research. Computer tomography (or better magnetic resonance imaging with intravenous contrast enhancement) allows not only To detect the tumor, but also to differentiate this disease from a number of others with the symptoms of the patient the cerebellum. Using MRI, you can see the features of the structure of the tumor, its location relative to the vasculature and a number of other signs that will help the treating doctor during the operation to remove the tumor.

Treatment

The main method of treating a cerebellar tumor is surgical intervention. It is desirable radical, that is, total removal of tumor tissue, but this is not always technically feasible. If the tumor sprouts surrounding tissue, IV ventricle, then, of course, it is impossible to completely remove it. In this case, try to remove as much tumor tissue as possible. In any case, the neurosurgeon does everything in order to restore the disturbed circulation of the CSF. For this purpose, part of the occipital bone and part of the first cervical vertebra can be removed (this helps to eliminate compression of the brain stem).

In malignant tumors of the cerebellum (which is established histologically) after surgical treatment radiotherapy, which has the goal of destroying possibly remaining tumor cells. Chemotherapy is also possible. The type and volume of treatment is determined by the histological variant of the cerebellum tumor.

It should be understood that if the tumor is not completely removed, then after a while it will again grow and give again clinical symptoms.

In addition, in the treatment of cerebellar tumors, medications are used to carry out symptomatic treatment. It can be antiemetic, diuretic, anesthetics, hormones and so on. They, of course, in no way affect the tumor itself, but contribute to the improvement of the patient's condition.

Thus, the cerebellum tumor is a type of brain tumor. Given the anatomical location of the cerebellum in the cranial cavity, its tumors have distinctive symptoms that are not always associated with the defeat of the cerebellum tissue. As the tumor grows, new and new symptoms always appear. The decisive method of diagnosis in a cerebellar tumor is magnetic resonance imaging with intravenous enhancement by contrast. To get rid of the tumor of the cerebellum can only be through surgery. Unfortunately, not always surgical intervention leads to recovery of patients with this ailment.