TABLE 98.4 TUMORS AFFECTING THE CENTRAL NERVOUS SYSTEM Location Specific tumor types Presenting signs and symptoms Comments Supratentorial hemispheric Low-grade gliomas Pilocytic Fibrillary High-grade glioma Mixed neuronal-glial neoplasms Ganglioglioma Ependymoma Choroid plexus tumors Primitive neuroectodermal tumor (PNET) Chiasmatic/hypothalamic glioma Craniopharyngioma Germinoma/malignant germ cell tumors Pineoblastoma PNET Varies with site Hemiparesis Hemisensory deficits Seizure Hemianopsia Outcome for these tumors usually improved by extensive resection Vision deficits Diencephalic syndrome Neuroendocrine symptoms Hydrocephalus Parinaud syndrome Germinoma and germ cell tumors require biopsy; treatment usually chemotherapy not surgery Medulloblastoma Cerebellar astrocytoma Ependymoma Diffuse malignant brainstem glioma Benign focal brainstem glioma Cranial nerve palsies Cerebellar signs Ataxia Dysmetria Brainstem signs Weakness Unsteady gait Increased intracranial pressure Supratentorial midline Infratentorial