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Key Clinical Updates in Intracranial & Spinal Mass Lesions

Memantine (5 mg once daily orally titrated by 5 mg weekly to 10 mg twice daily) reduced cognitive toxicity associated with whole-brain radiotherapy in a randomized trial and is recommended; this effect can be augmented through intensity modulated radiation therapy with hippocampal avoidance.

Brown PD et al. J Clin Oncol. [PMID: 32058845]

1. PRIMARY INTRACRANIAL TUMORS

ESSENTIALS OF DIAGNOSIS

  • Generalized or focal disturbance of cerebral function, or both.

  • Increased intracranial pressure in some patients.

  • Neuroradiologic evidence of space-occupying lesion.

General Considerations

Roughly one-third of all primary intracranial neoplasms (Table 24–4) are meningiomas, one-quarter are gliomas, and the remainder are pituitary adenomas (see Chapter 26), neurofibromas, and other tumors. Certain tumors, especially neurofibromas, hemangioblastomas, and retinoblastomas, may have a familial basis, and congenital factors bear on the development of craniopharyngiomas. Tumors may occur at any age, but certain gliomas show particular age predilections.

Table 24–4.Primary intracranial tumors (listed by major histology grouping and by incidence within each group).

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