Tumours of the posterior fossa intrinsic

CEREBELLAR METASTASIS

In adults, metastasis is the commonest tumour of the cerebellar hemisphere. Primary tumour sites match those of supratentorial lesions (page 311).

Clinical features: may present acutely or progress over several months.

_, CSF obstruction hydrocephalus - signs and symptoms of raised intracranial pressure.

Cerebellar signs - ataxia, nystagmus, dysarthria, inco-ordination.

4th ventricle displaced

4th ventricle displaced

Extension into the cerebello-pontine angle may damage cranial nerves V-XII - especially if a malignant plaque develops.

Investigations

CT scan shows a well-defined solid or cystic lesion lying within the cerebellar hemisphere and enhancing irregularly with contrast.

Obstructive hydrocephalus is often evident on higher scan cuts. As with cerebral metastases MRI is more sensitive.

Management

Operative removal of a single metastasis through a suboccipital craniectomy is worthwhile, provided the patient has a reasonable prognosis from the primary tumour. Risks are small -extensive cerebellar hemisphere resection (on one side) seldom produces any significant permanent deficit. A course of radiotherapy can follow operation if resection is incomplete. Persistence of obstructive hydrocephalus requires a ventriculoperitoneal shunt.

HAEMANGIOBLASTOMA

This benign tumour of vascular origin occurs primarily in the middle-aged; it is slightly more prevalent in males and is the commonest primary cerebellar tumour of adults. In some patients, haemangioblastomas occur at other sites, e.g. the spinal cord and retina and may be associated with other pathologies, e.g. polycythaemia and cysts in the pancreas and kidneys - Von Hippel-Lindau disease (page 542).

Reddish brown tumour nodule -usually associated with a cystic cavity containing xanthochromic fluid

Abnormal vessels often present on cerebellar surface

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