Clinics in neurology and neurosurgery of sport: mass lesions. Benign brain tumours
- 1Cabrini Medical Centre, Malvern, Victoria, Australia
- 2Fusion Medical Education LLC, Wakefield, Massachusetts, USA
- 3Hopital Lariboisi, University of Paris VII, Paris, France
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
- 5University of Virginia, Charlottsville, Virginia, USA
- 6Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
- Correspondence to Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu
- Accepted 5 June 2008
- Published Online First 20 May 2009
When athletes are investigated for acute neurological symptoms a brain scan may reveal a tumour or mass lesion. Occasionally, these are incidental findings. The location of the tumour in the brain will critically affect its clinical presentation. A tumour compressing the optic nerve will result in visual loss, a tumour obstructing the cerebral aqueduct will cause hydrocephalus, and a tumour in the hippocampus may cause epilepsy.
The biology of the tumour determines its growth propensity and aggressiveness. Although tectal plate glioma and glioblastoma multiforme are both classified as astrocytomas, the behaviour of each is completely different. A tectal platei glioma is a very slow-growing, indolent lesion, often remaining stable for many years without the requirement for any treatment, whereas a glioblastoma multiforme is aggressive and invasive, and can grow rapidly within a few weeks. Similarly, the classification of meningiomas includes tumours with a broad spectrum of clinical behaviour. A benign convexity meningioma grows very slowly and is cured with complete resection, whereas a skull base meningioma can invade bone, brain, vascular and neural structures. Tumour biology also affects the brain’s reaction to the tumour, such as the development of cerebral oedema surrounding the lesion.
Treatment of tumours takes these and other factors into account, including patient age and functional level, comorbidity, neurological deficits and seizures. Depending on the tumour type, location and clinical presentation, treatment options include any combination of surgical resection, radiosurgery, radiotherapy, chemotherapy, and treatment of associated phenomena such as hydrocephalus and seizures.
The athlete with a high-grade aggressive tumour with pronounced neurological deficit is unlikely to return to elite sport, but a sportsman with an incidental benign brain tumour will probably want to return and may be able to do so. This forum is inappropriate for a detailed discussion of the management of all brain tumours, …
