Intracranial Tumours Investigation

Chest X-ray ESR

The high incidence of metastatic tumour makes these tests mandatory in patients with suspected intracranial tumour.

Signs of raised intracranial pressure

- Suture separation (diastasis)

- in infants

- 'Beaten brass' appearance - of limited value since it may occur normally in children and in

J J some adults.

Lateral view

Skull X-ray Note:

Calcification s

- oglidendroglioma N

- meningioma (look for hyperostosis of adjacent bone)

- craniopharyngioma

Osteolytic lesion

- primary or secondary bone tumour

- dermoid/epidermoid

- chordoma

- nasopharyngeal carcinoma

- myeloma

- reticulosis

CT scanning Note:

SITE

e.g. frontal, occipital

brain substance, e.g. meningioma

- intrinsic: within ^ brain parenchyma, e.g. astrocytoma.

MASS EFFECT / -midline shift. - ventricular compression, -hydrocephalus (secondary to 3rd ventricular or posterior fossa lesion).

-------/---)>---erosion of the posterior clinoids

I (may also occur from local pressure, e.g. craniopharyngioma.

Lateral view

Towne's view

Towne's view

Pineal shift -if gland is calcified (ensure 'shift' is not due to film rotation).
Effect on adjacent bone i.e. if meningioma -> hyperostosis

Single or multiple lesions if multiple -> metastasis

Effect of contrast enhancement e.g. none - low grade astrocytoma irregular - malignant astrocytoma homogeneous - meningioma

HIGH DEFINITION SCANS (1.5 mm slice width) - useful in the detection of pituitary, orbital and posterior fossa tumours.

CORONAL AND SAGITTAL RECONSTRUCTION DIRECT CORONAL SCANNING

useful in demonstrating the vertical extent of a tumour and its relationship with other structures - especially when intraventricular or arising from the pituitary fossa or skull base. Now replaced by MRI.

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