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

✓ 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.

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

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.4.7 ◽

1997 ◽

Vol 2 (4) ◽

pp. E6 ◽

Cited By ~ 1

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.

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

Journal of Neurosurgery ◽

10.3171/jns.1999.91.3.0375 ◽

1999 ◽

Vol 91 (3) ◽

pp. 375-383 ◽

Cited By ~ 72

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.

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Gamma knife radiosurgery for craniopharyngiomas

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0047 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 47-56 ◽

Cited By ~ 107

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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Role of hydrodynamic processes in the pathogenesis of peritumoral brain edema in meningiomas

Journal of Neurosurgery ◽

10.3171/jns.2000.93.4.0594 ◽

2000 ◽

Vol 93 (4) ◽

pp. 594-604 ◽

Cited By ~ 26

Author(s):

Michael Bitzer ◽

Thomas Nägele ◽

Beverly Geist-Barth ◽

Uwe Klose ◽

Eckardt Grönewäller ◽

...

Keyword(s):

Contrast Agent ◽

Brain Edema ◽

Brain Tissue ◽

Magnetic Resonance Images ◽

Content Type ◽

Extracellular Contrast Agent ◽

Peritumoral Brain Edema ◽

Hydrodynamic Processes ◽

Fine Print

Object. In a prospective study, 28 patients with 32 intracranial meningiomas were examined to determine the role of hydrodynamic interaction between tumor and surrounding brain tissue in the pathogenesis of peritumoral brain edema.Methods. Gadolinium—diethylenetriamine pentaacetic acid (Gd-DPTA), an extracellular contrast agent used for routine clinical imaging, remains strictly extracellular without crossing an intact blood—brain barrier. Therefore, it is well suited for investigations of hydrodynamic extracellular mechanisms in the development of brain edema. Spin-echo T1-weighted magnetic resonance images were acquired before and after intravenous administration of 0.2 mmol/kg Gd-DPTA. Additional T1-weighted imaging was performed 0.6, 3.5, and 6.5 hours later. No significant Gd-DPTA diffused from tumor into peritumoral brain tissue in 12 meningiomas without surrounding brain edema. In contrast, in 17 of 20 meningiomas with surrounding edema, contrast agent in peritumoral brain tissue was detectable after 3.5 hours and 6.5 hours. In three of 20 meningiomas with minimum surrounding edema (< 5 cm3), contrast agent effusion was absent. After 3.5 hours and 6.5 hours strong correlations of edema volume and the maximum distance of contrast spread from the tumor margin into adjacent brain parenchyma (r = 0.84 and r = 0.87, respectively, p < 0.0001) indicated faster effusion in larger areas of edema.Conclusions. The results of this study show that significant contrast agent effusion from the extracellular space of the tumor into the interstitium of the peritumoral brain tissue is only found in meningiomas with surrounding edema. This supports the hypothesis that hydrodynamic processes play an essential role in the pathogenesis of peritumoral brain edema in meningiomas.

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Therapeutic effects of local delivery of dexamethasone on experimental brain tumors and peritumoral brain edema

Journal of Neurosurgery ◽

10.3171/jns.1993.79.5.0716 ◽

1993 ◽

Vol 79 (5) ◽

pp. 716-721 ◽

Cited By ~ 5

Author(s):

Yukio Ikeda ◽

Benjamin S. Carson ◽

Jeremy A. Lauer ◽

Donlin M. Long

Keyword(s):

Brain Tumors ◽

Brain Edema ◽

Tumor Volume ◽

Osmotic Pump ◽

Therapeutic Modality ◽

Therapeutic Effects ◽

Content Type ◽

Treatment Groups ◽

Experimental Brain Tumors ◽

Dexamethasone Therapy

✓ To determine if dexamethasone administered by osmotic pump directly to brain tumors would control peritumoral edema and at the same time suppress tumor growth and prolong survival, the authors studied experimental brain tumors produced in 102 rabbits by implanting VX2 carcinoma cells. Of these, 58 animals were separated into three treatment groups: Group 1 included 15 untreated rabbits; Group 2 included 18 rabbits treated with systemic dexamethasone (4 mg/kg/day); and Group 3 included 25 rabbits treated with local dexamethasone (0.24 mg/day) delivered by osmotic pump. Systemic or local dexamethasone was administered from Day 3 or Day 7 after tumor implantation, and animals were sacrificed on Day 13. A survival study was performed with 44 rabbits separated into the same treatment groups, beginning drug delivery on Day 7. Brain water content in the white matter of sacrificed animals was measured by the specific gravity method. The length and width of the brain tumors in all animals were measured and the tumor volume estimated. Findings showed that systemic and local dexamethasone administered from Day 3 or Day 7 was associated with a significant (5% level) inhibition of tumor volume as well as a mean reduction of brain edema in most tested sites. Systemic and local dexamethasone therapy also resulted in a significant (5% level) increase in survival time relative to the untreated group. These short-term results suggest that locally delivered dexamethasone may constitute a clinically important therapeutic modality.

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Effects of methylprednisolone on peritumoral brain edema

Journal of Neurosurgery ◽

10.3171/jns.1983.59.4.0612 ◽

1983 ◽

Vol 59 (4) ◽

pp. 612-619 ◽

Cited By ~ 59

Author(s):

Kazuo Yamada ◽

Yukitaka Ushio ◽

Toru Hayakawa ◽

Norio Arita ◽

Noriko Yamada ◽

...

Keyword(s):

Blood Flow ◽

Brain Edema ◽

Capillary Permeability ◽

Clinical Symptoms ◽

Treated Group ◽

Untreated Group ◽

Content Type ◽

Intracerebral Transplantation ◽

Edema Fluid ◽

Peritumoral Brain Edema

✓ Peritumoral brain edema was produced by intracerebral transplantation of Walker 256 tumor in rats. Local cerebral blood flow (LCBF), local cerebral glucose utilization (LCGU), and capillary permeability were studied in untreated and methylprednisolone-treated rats by quantitative autoradiography. In the untreated group, LCBF and LCGU were widely depressed in the cortex and deep structures of the hemisphere ipsilateral to the tumor. In the methylprednisolone-treated animals, LCBF and LCGU were significantly better than in the untreated animals. Capillary permeability was highly increased in the viable part of the tumor in the untreated animals. In the methylprednisolone-treated group, capillary permeability of the tumor was significantly lower than that in the untreated group. These results may suggest that increase in capillary permeability of the tumor is the major source for edema fluid production, and that methylprednisolone improves brain edema by decreasing capillary permeability of the tumor. Decrease in edema fluid formation may result in restoration of blood flow and glucose metabolism in the adjacent brain tissue, and may improve clinical symptoms and signs.

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Volume reduction in meningiomas after gamma knife surgery

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0189 ◽

2005 ◽

Vol 102 ◽

pp. 189-194 ◽

Cited By ~ 26

Author(s):

Guenther C. Feigl ◽

Otto Bundschuh ◽

Alireza Gharabaghi ◽

Madjid Samii ◽

Gerhard A. Horstmann

Keyword(s):

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Volume Reduction ◽

World Health ◽

Tumor Control ◽

Content Type ◽

The Mean ◽

Fine Print

Object.The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment.Methods.A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter.The mean tumor volume was 5.9 cm3(range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase.Conclusions.Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.

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Evaluation of a new concept for the management of skull base chordomas and chondrosarcomas

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0165 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 165-170 ◽

Cited By ~ 10

Author(s):

Guenther Christian Feigl ◽

Otto Bundschuh ◽

Alireza Gharabaghi ◽

Sam Safavi-Abassi ◽

Amr El Shawarby ◽

...

Keyword(s):

Skull Base ◽

Tumor Volume ◽

Tumor Resection ◽

Volume Reduction ◽

Recurrence Rates ◽

Content Type ◽

The Mean ◽

Tumor Volume Reduction ◽

Fine Print

Object. Chordomas and chondrosarcomas of the skull base are rare locally invasive tumors associated with high recurrence rates. The aim of this study was to evaluate the concept of microsurgical tumor volume reduction followed by early gamma knife surgery (GKS). Methods. Thirteen patients with 15 tumors were treated between October 2000 and June 2003. There were three patients (23.1%) with chordomas and 10 (76.9%) with chondrosarcomas. There were nine men and four women who ranged in age between 19 and 69 years. All patients first underwent maximal tumor resection. Within 2 to 10 months after surgery they were treated with GKS. The mean postoperative tumor volume treated with GKS was 9.7 cm3 (range 1.4–20.3 cm3). Follow-up computerized tomography and magnetic resonance imaging examinations with volumetric tumor analysis were performed every 6 months after GKS. The mean treatment dose was 17 Gy and the mean isodose was 52%. The mean follow-up duration was 17 months during which there was only one tumor recurrence at the margin of the radiation field. The mean volume reduction was 35.4%. Conclusions. Results of this treatment strategy are encouraging but the efficacy of this multimodal treatment combining surgery and early GKS requires a longer follow up.

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

Neurosurgery ◽

10.1097/00006123-200111000-00003 ◽

2001 ◽

Vol 49 (5) ◽

pp. 1046-1052 ◽

Cited By ~ 16

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.

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