Intracranial tumors (summary)

Last revised by Rohit Sharma on 22 Feb 2024
This is a basic article for medical students and other non-radiologists

Intracranial tumors comprise a heterogeneous group of tumors. In adult patients, the majority represent metastatic disease with a smaller proportion being primary brain tumors. Metastasis to the brain occurs, most commonly, from lung, breast, melanoma, renal cell, and colorectal cancers.

Reference article

This is a summary article; read more in our article on intracranial tumors.

  • epidemiology

    • incidence increases with age

    • equivocal gender distribution

    • risk factors

      • malignancy elsewhere

  • presentation

    • headache

    • features of raised intracranial pressure

      • nausea & vomiting worse in the morning or positional

    • altered mental state

    • focal neurology may occur as the tumor grows

    • adult-onset seizures

    • incidental finding

      • some tumors may not cause symptoms

      • patients may be imaged for another reason, e.g. trauma

  • pathophysiology

    • heterogeneous group of tumors

      • metastases, e.g. lung, breast, renal

      • meningiomas

      • primary parenchymal tumors

      • pituitary or pineal tumors

      • cranial nerve schwannomas

    • tumors are graded using the WHO grade

  • investigation

    • CT is often the first test performed to assess presenting symptoms

    • MRI may be used with symptoms of headaches or seizures

    • MRI is the investigation of choice to characterize the tumor

  • treatment

    • parenchymal brain tumors generally have a poor prognosis

    • treatment should be in specialist centers

      • steroids may alleviate symptoms caused by edema

      • antiseizure medications may help for those with seizures

      • a biopsy may be performed neurosurgically

      • some tumors may be removed, e.g. pituitary tumors

      • stereotactic radiotherapy can be used for small lesions

  • role of imaging

    • confirm intracranial abnormality and prioritise MRI

    • tumor characterization

    • help to determine the grade, and make a decision about biopsy

    • follow up

  • radiographic features

    • CT

      • often the first line test

      • variety of appearances depending on the tumor

      • hypo- or hyperdense, irregular, well-defined, peripheral or deep

      • useful to determine edema and mass effect

      • contrast may make lesions more conspicuous

      • CT is especially helpful for determining bony involvement

    • MRI

      • investigation of choice

      • fantastic contrast and spatial resolution

      • origin of tumors can be determined

      • different sequences are used to determine the likely diagnosis

      • specialized sequences can be useful to look at tumor metabolites

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