Neuro-oncology

Among the malignant brain cancers, gliomas of the brainstem and pons, glioblastoma multiforme, and high-grade (highly anaplastic) astrocytoma/oligodendroglioma are among the worst.

[1] In these cases, untreated survival usually amounts to only a few months, and survival with current radiation and chemotherapy treatments may extend that time from around a year to a year and a half, possibly two or more, depending on the patient's condition, immune function, treatments used, and the specific type of malignant brain neoplasm.

Metastasis to dural structures generally occurs by hematogenous spread or direct invasion from a contiguous bone.

Dural metastases can invade the underlying brain and cause focal edema and associated neurologic symptoms.

The rapid growth of fast-growing high-grade brain tumors may damage the subcortical network essential for electrical transmission, whereas slow-growing tumors have been suggested to induce partial deafferentation of cortical regions, causing denervation hypersensitivity and producing an epileptogenic milieu.

Studies strongly suggest that genetic factors may play a role in tumor development and tumor-related epilepsy.

[3][4] Recent work has demonstrated a close link between seizure activity and high extracellular glutamate in tumor-related epilepsy.

Glutamate activation of ionotropic receptors leads to a rapid excitatory signal based on cation influx that can cause release of calcium from intracellular stores.

[7][8] Lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis are important for the evaluation of some primary tumors, metastatic conditions, and neurologic complications of cancer.