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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.99 n.6 Pretoria Jun. 2009

 

Pathological features of intracranial masses

Oedema

Vasogenic oedema was present with all the infective masses and most tumours (n = 77/92 = 83.7%). The most common tumours associated with the oedema were in the infratentorial compartment.

These results correlate with literature that reports that both brain pathologies, tumours and infective masses, cause damage to the blood-brain barrier (BBB). In tumours, BBB damage is secondary to tumour angiogenesis. Infections actually result in both vasogenic and cytotoxic oedema (combined oedema), with cytotoxic oedema initially occurring from the derangement of the adenosine-dependent triphosphate (ATP) -transmembrane sodium-potassium and calcium pumps. Initially, the BBB is spared, but with increasing insult severity, cell death occurs, which then damages the BBB and results in vasogenic oedema.30

Hydrocephalus

Within the infratentorial group, the majority of tumours, (n = 45/47, 96%) and infections, (n = 2/4, 50%) were associated with hydrocephalus, compared to the supratentorial group (tumours, n = 35/45, 77.8%; infections, n = 1/11, 9%). This is not surprising because of the anatomical relationship of infratentorial masses with CSF drainage pathways, which result in obstruction of CSF flow attributable to compression of the fourth ventricle. This finding corresponds with the literature.31 Sindi Lam et al. reported that hydrocephalus occurs in 71% - 90% of infratentorial tumours.32 Hydrocephalus in supratentorial masses is secondary to obstruction of the third ventricle and cerebral aqueduct.

Herniation

Thirty-nine percent of the patients had associated herniation, secondary to raised ICP. Most masses were located in the infratentorial compartment (n = 22/51, 43.1%), causing tonsillar herniation. This occurs when there is increased pressure in the posterior fossa, causing herniation of the cerebellar tonsil through the foramen magnum.33 This can be attributable to the size of the mass (large mass) and the presence of significant associated vasogenic oedema. Supratentorial masses were associated with subfalcine herniation (n = 18/56, 32.1%), where increased pressure caused herniation of the cingulate gyrus beneath the falx cerebri.33

 

Limitations of the study

The limitation of this study was the retrospective design and the single centre study. However, all paediatric patients with intracranial mass masses were managed at a single tertiary centre in the province of KZN. A larger cohort may have provided more information.

 

Conclusion

In this series, the supratentorial compartment was the most common site for intracranial masses overall. The most common tumour was, however, a medulloblastoma, located in the infratentorial compartment. This information is an important guide when developing the differential diagnosis of common intracranial masses in paediatric patients referred to our institution and in planning further management.

 

Acknowledgements

The authors acknowledge the IALCH radiology staff for all their support relating to data collection and the support of the Department of Health authority gatekeepers.

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors' contributions

N.P.G. was the principal investigator and prepared the manuscript. B.E. and S.M.L. provided supervisory roles, made conceptual contributions towards the study and participated in the manuscript editing.

Funding information

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

Data that support the findings of this study are available from the corresponding author, upon reasonable request.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

 

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