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An advantage of using 3D multicellular spheres to study tumor biology is that they better approximate the interactions encountered by cells in vivo. Our previous studies have shown that the process of spheroid formation is governed by the same thermodynamic principles driving the formation of liquid droplets. This liquid-like behavior enables us to measure a key property influencing tumor behavior, namely, intercellular cohesion. We have developed a method, tissue surface tensiometry (TST), to measure the cohesivity, expressible as surface tension (), of tissue aggregates under physiologic conditions. This study utilizes TST to measure the cohesivity of 3 widely used malignant astrocytoma cell lines of different in vitro invasive potentials. We compare invasiveness with aggregate cohesivity and with the expression of N-cadherin, a key mediator of cell-cell cohesion in neural tissues. We show that the cell lines exhibit liquid-like behavior since they form spheroids whose surface tension is both force-and volumeindependent; that aggregates from each cell line have a distinct surface tension that correlates with their in vitro invasive capacity; that dexamethasone (Dex), a widely used therapeutic agent for the treatment of tumor-related cerebral edema, increases aggregate cohesivity and decreases invasiveness; that dexamethasone treatment decreases invasion in a dose-dependent manner but only when cells are in direct contact with one another; and that dexmediated decreased invasiveness correlates with increased aggregate cohesivity as measured by TST but not with N-cadherin expression or function. Our results demonstrate that for these cell lines, cohesivity is an excellent predictor of in vitro invasiveness. © 2004 Wiley-Liss, Inc. Key words: tissue surface tensiometry; malignant astrocytoma; cohesivity; invasion; dexamethasone Glioblastoma multiforme (GBM) represent approximately 60% of all gliomas and 30% of all intracranial tumors. 1 The hallmark of these aggressive tumors is their ability to invade the brain rapidly. Typically, at the time of diagnosis, tumor cells have already spread at least 2 cm beyond the main tumor mass. This rapid local invasion, along with their intrinsic resistance to radiation and chemotherapy, is one of the key factors in primary brain tumor resistance to current forms of therapy. Unfortunately, the current system of histopathologic staging provides a poor approximation of the behavior of an individual tumor. Some histologically lowgrade tumors rapidly invade the brain, while some tumors graded histologically as aggressive do not behave as aggressively as their histology would predict. Newer molecular classifications of brain tumors as yet have failed to provide a more accurate prediction of tumor behavior.Molecular mechanisms underlying malignant brain tumor invasion have been intensively studied over the last 20 years. Many factors have been identified as either facilitators or inhibitors of brain tumor invasion, including cytokines, 2 lymphokines, 3 adhesion molecules, 4 growt...

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Intracranial hypertension following traumatic brain injury is associated with considerable morbidity and mortality. Hemorrhagic hypovolemia commonly coexists with head injury in this population of patients. Therapy directed at correcting hypovolemic shock includes vigorous volume expansion with crystalloid solutions. It is hypothesized that, following traumatic brain injury, cerebrovascular dysfunction results in rapid loss of brain compliance, resulting in increased sensitivity to cerebrovascular venous pressure. Increased central venous pressure (CVP) occurring with vigorous crystalloid resuscitation may therefore contribute to the loss of brain compliance and the development of intracranial hypertension. The authors tested this hypothesis in miniature swine subjected to traumatic brain injury, hemorrhage, and resuscitation. Elevated CVP following resuscitation from hemorrhage to a high CVP significantly worsened intracranial hypertension in animals with concurrent traumatic brain injury, as compared to animals subjected to traumatic brain injury alone (mean +/- standard error of the mean: 33.0 +/- 2.0 vs. 20.0 +/- 2.0 mm Hg, p < 0.05) or to animals subjected to the combination of traumatic brain injury, hemorrhage, and resuscitation to a low CVP (33.0 +/- 2.0 vs. 24.0 +/- 2.0 mm Hg, p < 0.05). These data support the hypothesis that reduction in brain compliance can occur secondary to elevation of CVP following resuscitation from hemorrhagic shock. This may worsen intracranial hypertension in patients with traumatic brain injury and hemorrhagic shock.

The role of surgery in the treatment of metastatic brain tumors has always been a source of controversy. It was only in the early 1990s that two randomized prospective trials demonstrated that surgery plus radiation therapy improved survival in patients with single metastatic brain tumors vs. radiation therapy alone. This paper reviews these articles as well as other evidence outlining management options for multiple brain metastases. An attempt has been made to better define the role of surgery in brain metastases. The prognostic factors for brain metastases after surgery are also reviewed and the data comparing stereotactic radiosurgery to surgery is examined. A short description of surgical planning, operative techniques and tools, followed by a discussion on complication avoidance before, during, and after surgery is included.