Management

There are no definitive guidelines for the management of intracranial tumours. Each lesion requires due consideration of:

• grade - benign or malignant
• site - how approachable
• type - is this known with certainty and if so, does it lend itself to conservative treatment.

In general, conservative therapy is the treatment of choice wherever specific measures exist, e.g. pituitary adenomas.

Benign tumours are best treated by excision except where they are inaccessible or are attached to adjacent structures.

The management of malignant tumours and non-excisable benign lesions is more complex. Any existing oedema may be reduced using steroids such as dexamethasone with diuretics such as mannitol to lower ICP. The difficulty is then of deciding when and how to operate. Monitoring with repeat CT scans may be appropriate for small, asymptomatic tumours; the initial CT provides a baseline against which to assess the progress of the tumour.

Burr hole or stereotactic biopsy may be performed to further identify the histology of the lesion. Depending upon the nature and site of the tumour, this may then be followed by partial or complete removal.

Radiotherapy is often used either alone or following surgery. Many but not all intracranial tumours are radiosensitive.

Chemotherapy has to date been disappointing. The main difficulty is in finding a drug which will cross the blood brain barrier. BCNU, CCNU, vincristine and methotrexate may be used depending upon the tumour type.