scholarly journals The importance of pial blood supply to the development of peritumoral brain edema in meningiomas

1997 ◽  
Vol 2 (4) ◽  
pp. E6 ◽  
Author(s):  
Michael Bitzer ◽  
Lars Wöckel ◽  
Andreas R. Luft ◽  
Ajay K. Wakhloo ◽  
Dirk Petersen ◽  
...  
Keyword(s):  
Brain Edema ◽  
Blood Supply ◽  
Tumor Size ◽  
Tumor Volume ◽  
Volume Ratio ◽  
Total Tumor Volume ◽  
Pial Vessels ◽  
Peritumoral Brain Edema ◽  
Tumor Region ◽  
The Mean

The authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema-tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3.0) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas in which 10% of the whole tumor volume was supplied by pial vessels had only a small mean EI of 2.2, whereas tumors with pial blood supply greater than or equal to 20% had a mean EI of 3.3 (p < 0.026). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be causative for the development of PTBE in meningiomas.

The importance of pial blood supply to the development of peritumoral brain edema in meningiomas

1997 ◽  
Vol 87 (3) ◽  
pp. 368-373 ◽  
Author(s):  
Michael Bitzer ◽  
Lars Wöckel ◽  
Andreas R. Luft ◽  
Ajay K. Wakhloo ◽  
Dirk Petersen ◽  
...  
Keyword(s):  
Brain Edema ◽  
Blood Supply ◽  
Tumor Volume ◽  
Volume Ratio ◽  
Content Type ◽  
Total Tumor Volume ◽  
Pial Vessels ◽  
Peritumoral Brain Edema ◽  
Tumor Region ◽  
The Mean

✓ In a retrospective analysis, the authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema—tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas with a smaller pial supply than dural supply had a significantly smaller mean EI than tumors with a pial supply equal to or greater than the dural supply (EI = 2.9 vs. EI = 3.7; p < 0.015). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be associated with the development of PTBE in meningiomas.

Peritumoral Brain Edema in Intracranial Meningiomas: Effects of Radiological and Histological Factors

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1046-1052 ◽  
Author(s):  
Takashi Tamiya ◽  
Yasuhiro Ono ◽  
Kengo Matsumoto ◽  
Takashi Ohmoto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Relative Risk ◽  
Magnetic Resonance ◽  
Brain Edema ◽  
Blood Supply ◽  
Tumor Size ◽  
Resonance Imaging ◽  
Tumor Vascularity ◽  
Intracranial Meningiomas ◽  
Peritumoral Brain Edema

ABSTRACT OBJECTIVE We examined the radiological and histological features influencing the development of peritumoral brain edema (PTBE) among patients with meningiomas. METHODS Factors causing PTBE were retrospectively analyzed for 125 patients with primary intracranial meningiomas. These factors included tumor size, tumor location, brain-tumor interface, signal intensity on T2-weighted scans, contrast enhancement, and cyst formation (as observed on magnetic resonance imaging scans), as well as tumor vascularity and blood supply (as observed in digital subtraction angiography studies). We defined the edema/tumor volume ratio as the edema index, and we used this index to evaluate PTBE. RESULTS A relationship between the tumor size and the volume of PTBE was observed. Convexity and middle fossa meningiomas demonstrated the greatest increases in mean edema indices. Meningothelial, anaplastic, microcystic, and angiomatous subtypes exhibited higher edema indices than did other types. Multivariate analysis demonstrated two significant radiological factors: cortical penetration (as defined by the disappearance of the arachnoid layer on magnetic resonance imaging scans) (relative risk, 2.067;P = 0.0148) and vascular supply from the pial-cortical arteries (as observed on angiograms) (relative risk, 2.087;P = 0.0082). CONCLUSION Tumor infiltration into adjacent brain parenchyma and a pial-cortical blood supply are critical factors for the development of PTBE among patients with meningiomas.

Peritumoral Brain Edema in Meningiomas Depends on Aquaporin-4 Expression and Not on Tumor Grade, Tumor Volume, Cell Count, or Ki-67 Labeling Index

2016 ◽  
Vol 19 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Matthias Gawlitza ◽  
Eckhard Fiedler ◽  
Stefan Schob ◽  
Karl-Titus Hoffmann ◽  
Alexey Surov
Keyword(s):  
Cell Count ◽  
Brain Edema ◽  
Tumor Volume ◽  
Tumor Grade ◽  
Labeling Index ◽  
Aquaporin 4 ◽  
Ki 67 ◽  
Peritumoral Brain Edema ◽  
Volume Cell

α-Fetoprotein-to-Total Tumor Volume Ratio Predicts Post-operative Tumor Recurrence in Hepatocellular Carcinoma

2012 ◽  
Vol 17 (4) ◽  
pp. 730-738 ◽  
Author(s):  
Yun-Hsuan Lee ◽  
Chia-Yang Hsu ◽  
Yi-Hsiang Huang ◽  
Chien-Wei Su ◽  
Han-Chieh Lin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Recurrence ◽  
Tumor Volume ◽  
Volume Ratio ◽  
Total Tumor Volume

scholarly journals Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

1999 ◽  
Vol 7 (1) ◽  
pp. E2 ◽  
Author(s):  
Ross E. Mantle ◽  
Boleslaw Lach ◽  
Mauricio R. Delgado ◽  
Salleh Baeesa ◽  
Gerard Bélanger
Keyword(s):  
Brain Edema ◽  
Computerized Tomography ◽  
Statistical Significance ◽  
Ct Scanning ◽  
Tumor Location ◽  
Complete Resection ◽  
Brain Invasion ◽  
Ottawa Civic Hospital ◽  
Peritumoral Brain Edema ◽  
The Mean

Object The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas. Methods One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 years (± 4 years, standard deviation [SD]) and the mean time to recurrence was 5 years (± 4 years, SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor. Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (rs = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 X 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1.00, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan-Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors. Conclusions Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.

scholarly journals Peritumoral Brain Edema in Metastases May Be Related to Glymphatic Dysfunction

2021 ◽  
Vol 11 ◽  
Author(s):  
Cheng Hong Toh ◽  
Tiing Yee Siow ◽  
Mauricio Castillo
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Brain Metastases ◽  
Brain Edema ◽  
Tumor Volume ◽  
Linear Regression Analysis ◽  
Cerebral Metastasis ◽  
Dynamic Susceptibility ◽  
Factors Associated ◽  
Peritumoral Brain Edema

ObjectivesThe proliferation of microvessels with increased permeability is thought to be the cause of peritumoral brain edema (PTBE) in metastases. The contribution of the glymphatic system to the formation of PTBE in brain metastases remains unexplored. We aimed to investigate if the PTBE volume of brain metastases is related to glymphatic dysfunction.Materials and MethodsA total of 56 patients with brain metastases who had preoperative dynamic susceptibility contrast-enhanced perfusion-weighted imaging for calculation of tumor cerebral blood volume (CBV) and diffusion tensor imaging for calculations of tumor apparent diffusion coefficient (ADC), tumor fractional anisotropy (FA), and analysis along perivascular space (ALPS) index were analyzed. The volumes of PTBE, whole tumor, enhancing tumor, and necrotic and hemorrhagic portions were manually measured. Additional information collected for each patient included age, sex, primary cancer, metastasis location and number, and the presence of concurrent infratentorial tumors. Linear regression analyses were performed to identify factors associated with PTBE volume.ResultsAmong 56 patients, 45 had solitary metastasis, 24 had right cerebral metastasis, 21 had left cerebral metastasis, 11 had bilateral cerebral metastases, and 11 had concurrent infratentorial metastases. On univariable linear regression analysis, PTBE volume correlated with whole tumor volume (β = -0.348, P = 0.009), hemorrhagic portion volume (β = -0.327, P = 0.014), tumor ADC (β = 0.530, P &lt;.001), and ALPS index (β = -0.750, P &lt;.001). The associations of PTBE volume with age, sex, tumor location, number of tumors, concurrent infratentorial tumor, enhancing tumor volume, necrotic portion volume, tumor FA, and tumor CBV were not significant. On multivariable linear regression analysis, tumor ADC (β = 0.303; P = 0.004) and ALPS index (β = -0.624; P &lt; 0.001) were the two independent factors associated with PTBE volume.ConclusionMetastases with higher tumor ADC and lower ALPS index were associated with larger peritumoral brain edema volumes. The higher tumor ADC may be related to increased periarterial water influx into the tumor interstitium, while the lower ALPS index may indicate insufficient fluid clearance. The changes in both tumor ADC and ALPS index may imply glymphatic dysfunction, which is, at least, partially responsible for peritumoral brain edema formation.

scholarly journals Predictive factors for the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

2019 ◽  
Author(s):  
Ryang-Hun Lee ◽  
Jae Min Kim ◽  
Jin Hwan Cheong ◽  
Je Il Ryu ◽  
Young Soo Kim ◽  
...  
Keyword(s):  
Brain Edema ◽  
Predictive Factors ◽  
Tumor Volume ◽  
Radiation Treatment ◽  
Characteristic Curve ◽  
Critical Role ◽  
Hazard Ratio ◽  
Intracranial Meningioma ◽  
Large Tumor ◽  
Peritumoral Brain Edema

AbstractBackground and purposeDisruption of the tumor-brain barrier in meningioma plays a critical role in the development of peritumoral brain edema (PTBE). We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation in patients with intracranial meningioma.MethodsWe measured Hounsfield units (HU) of the frontal skull on simulation brain CT in patients who underwent linear accelerator (LINAC)-based radiation treatment for intracranial meningioma. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for several predictive factors. The cumulative hazard for PTBE was estimated and classified according to these factors. Hazard ratios were then estimated to identify independent predictive factors associated with the development of PTBE after radiation in intracranial meningioma patients.ResultsA total of 83 intracranial meningiomas in 76 patients who received LINAC-based radiation treatment in our hospital over an approximate 5-year period were included for the study. We found mean frontal skull HU ≤630.625 and gross tumor volume >7.194 cc to be independent predictors of PTBE after radiation treatment in patients with meningioma (hazard ratio, 8.38; P=0.021; hazard ratio, 5.78; P=0.034, respectively). In addition, patients who were ≥65 years showed a marginally significant association with PTBE.ConclusionsOur study suggests that possible osteoporotic conditions, large tumor volume, and older age may be associated with PTBE occurrence after LINAC-based radiation treatment for intracranial meningioma. In the future we anticipate that these findings may enhance the understanding of the underlying mechanisms of PTBE after radiation in meningioma patients.

Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

1999 ◽  
Vol 91 (3) ◽  
pp. 375-383 ◽  
Author(s):  
Ross E. Mantle ◽  
Boleslaw Lach ◽  
Mauricio R. Delgado ◽  
Salleh Baeesa ◽  
Gerard Bélanger
Keyword(s):  
Brain Edema ◽  
Computerized Tomography ◽  
Statistical Significance ◽  
Ct Scanning ◽  
Complete Resection ◽  
Content Type ◽  
Brain Invasion ◽  
Peritumoral Brain Edema ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas.Methods. One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 ± 4 years (standard deviation [SD]) and the mean time to recurrence was 5 ± 4 years (SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor.Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (rs = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 × 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan—Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors.Conclusions. Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.

scholarly journals Kinetics of tumor size and peritumoral brain edema before, during, and after systemic therapy in recurrent WHO grade II or III meningioma

2015 ◽  
Vol 18 (3) ◽  
pp. 401-407 ◽  
Author(s):  
Julia Furtner ◽  
Veronika Schöpf ◽  
Katharina Seystahl ◽  
Emilie Le Rhun ◽  
Roberta Rudà ◽  
...  
Keyword(s):  
Brain Edema ◽  
Systemic Therapy ◽  
Tumor Size ◽  
Who Grade ◽  
Peritumoral Brain Edema ◽  
Grade Ii ◽  
Kinetics Of

Gamma knife radiosurgery for craniopharyngiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 47-56 ◽  
Author(s):  
Wen-Yuh Chung ◽  
David Hung-Chi Pan ◽  
Cheng-Ying Shiau ◽  
Wan-Yuo Guo ◽  
Ling-Wei Wang
Keyword(s):  
Clinical Outcome ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
Cystic Component ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

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