Hemorrhage in brain tumor – An unresolved issue

Ostrowski, Robert P.; He, Zhaohui; Pucko, Emanuela; Matyja, Ewa

doi:10.1016/j.hest.2022.01.005

Cited by 19 publications

(30 citation statements)

References 52 publications

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“…As the use of ultrasound in the therapeutic space is rapidly increasing, the present study raises important safety concerns for the clinical use of FUS, not only for CED applications but also for FUS-based brain stimulation techniques in neurorehabilitation after brain injury [ 68 ]. Since stroke- or tumor-related brain damage may compromise the mechanical integrity of the macro- and micro-scopic tissue/vascular environment (e.g., brain edema or necrotic/liquefaction changes) [ 69 , 70 , 71 , 72 ], FUS may significantly increase the risk of ICH. Age-dependent, unknown risk factors of ultrasonic brain stimulation may also exist in elderly adults [ 73 , 74 , 75 ], including patients with cerebral implants (such as brain shunts or aneurysm clips) who may receive unavoidable neurovascular insults.…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Intracerebral Hemorrhaging Associated with the Application of Low-Intensity Focused Ultrasound Following Acute Cerebrovascular Injury by Intracortical Injection

et al. 2022

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Low-intensity transcranial focused ultrasound (FUS) has gained momentum as a non-/minimally-invasive modality that facilitates the delivery of various pharmaceutical agents to the brain. With the additional ability to modulate regional brain tissue excitability, FUS is anticipated to confer potential neurotherapeutic applications whereby a deeper insight of its safety is warranted. We investigated the effects of FUS applied to the rat brain (Sprague-Dawley) shortly after an intracortical injection of fluorescent interstitial solutes, a widely used convection-enhanced delivery technique that directly (i.e., bypassing the blood–brain-barrier (BBB)) introduces drugs or interstitial tracers to the brain parenchyma. Texas Red ovalbumin (OA) and fluorescein isothiocyanate-dextran (FITC-d) were used as the interstitial tracers. Rats that did not receive sonication showed an expected interstitial distribution of OA and FITC-d around the injection site, with a wider volume distribution of OA (21.8 ± 4.0 µL) compared to that of FITC-d (7.8 ± 2.7 µL). Remarkably, nearly half of the rats exposed to the FUS developed intracerebral hemorrhaging (ICH), with a significantly higher volume of bleeding compared to a minor red blood cell extravasation from the animals that were not exposed to sonication. This finding suggests that the local cerebrovascular injury inflicted by the micro-injection was further exacerbated by the application of sonication, particularly during the acute stage of injury. Smaller tracer volume distributions and weaker fluorescent intensities, compared to the unsonicated animals, were observed for the sonicated rats that did not manifest hemorrhaging, which may indicate an enhanced degree of clearance of the injected tracers. Our results call for careful safety precautions when ultrasound sonication is desired among groups under elevated risks associated with a weakened or damaged vascular integrity.

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Section: Discussionmentioning

confidence: 99%

High Incidence of Intracerebral Hemorrhaging Associated with the Application of Low-Intensity Focused Ultrasound Following Acute Cerebrovascular Injury by Intracortical Injection

et al. 2022

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“…Articles published between 1990 and 2022 were considered. Of all the intracranial hemorrhages, only between 1% and 11% correspond to hemorrhagic brain tumors, most commonly seen in higher WHO grade ones like glioblastoma multiforme [6,7]. Concerning SAH, only about 0.4 % arise from tumor hemorrhage [6].…”

Section: Discussionmentioning

confidence: 99%

Let Us Not Forget About Bleeding: A Case Report and Brief Literature Review on Hemorrhagic Vestibular Schwannoma

Sousa¹,

Rego²,

Fernandes³

et al. 2022

Cureus

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Hemorrhagic vestibular schwannoma (HVS) consisting of acute intratumoral and subarachnoid hemorrhage is a rare phenomenon. We present the case of a 31-year-old woman who attended the Otorhinolaryngology department with right-sided intense tinnitus, dizziness, imbalance, and headache. Brain computed tomography revealed a spontaneous hyperdensity in the posterior fossa with marked deformation of the brainstem, middle cerebral peduncle, and cerebellum, with the near collapse of the fourth ventricle. Ophthalmology evaluation confirmed bilateral papilledema. Brain magnetic resonance imaging confirmed a voluminous 33 x 28 x 29 mm extra-axial lesion centered on the right pontine-cerebellar angle cistern, extending from the plane of the trigeminal nerve/tent of the cerebellum. The acoustic pore was enlarged. The patient underwent retrosigmoid craniotomy and microscopic tumor resection showing significant improvement in the follow-up. Pathological findings confirmed HVS. Delayed treatment of HVS can increase morbidity or even be fatal. The objective of this work is to describe and revise HVS, in order to bring awareness to this uncommon entity.

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“…Bleeding increases with tumor size and patient age. ITH is present in 5-10% of intracranial tumors on presentation, sometimes causing significant neurologic decline, but in some it may be minor and thus not symptomatic [83].…”

Section: Intracerebral Hemorrhage (Ich)mentioning

confidence: 99%

“…Highly malignant gliomas like glioblastoma, and brain metastases, tend to bleed the most. However, low-grade tumors like pilocytic astrocytoma, meningioma, pituitary adenoma, or hemangioblastoma can also bleed [83]. ITH in brain metastasis is an indicator of poor prognosis [84].…”

Section: Intracerebral Hemorrhage (Ich)mentioning

confidence: 99%

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Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

Faraj

Snyder²,

McCutcheon³

2022

Emerg Cancer Care

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Intracranial tumors pose a challenge in neurosurgery, especially when patients present emergently or require emergency surgery. Tackling an acute change in the patient’s mental status is the primary reason for seeking an emergency surgery in the setting of an intracranial tumor. In addressing tumor-related complications, the aim of surgery is to relieve elevated intracranial pressure (ICP), confirm a diagnosis, improve or stabilize function, and extend the patient’s life by preventing herniation.Tumors and peritumoral edema form a space-occupying lesion that causes mass effect on nearby structures and elevates ICP. Surgical management involves (1) external ventricular drain (EVD) placement to monitor ICP, lower the volume of cerebrospinal fluid (CSF), and temporarily treat intracranial hypertension, (2) resection of the space-occupying mass responsible for the rise in ICP, and (3) in some patients, decompressive craniectomy (DC). Patients with brain tumors may also present with hydrocephalus due to the tumor’s obstructing CSF flow or disrupting CSF absorption. Tumors also cause tumor-associated epilepsy (TAE) and status epilepticus (TASE). TASE is a life-threatening condition characterized by an abnormally prolonged generalized seizure (or a chain of multiple seizures) without recovery of consciousness to baseline. Time is of the essence when managing TAE and TASE, and surgical resection of the tumor-associated epileptogenic focus can be curative. Brain tumors and their treatment can also provoke ischemic stroke, intratumoral hemorrhage, and cerebral venous sinus thrombosis depending on their location. Hemorrhagic infarction of pituitary adenomas leading to rapid expansion of the sellar region and acute pituitary gland dysfunction is known as pituitary apoplexy. Here, optimizing the patient’s hemodynamic status and treating adrenal insufficiency are crucial upon presentation. Emergency surgical resection plays an important role in saving nearby neurovascular entities when conservative treatment proves inadequate. Finally, infections of the central nervous system (CNS) occur as a result of immunologic compromise caused by the tumor itself or by its treatment.In conclusion, in severe and rapidly progressing cases in which the patient presents with altered mental status and neurologic deficits, an emergency neurosurgical procedure is indicated for removal of the cause(s) of the excess ICP, protection of brain function, and monitoring of ICP.

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Hemorrhage in brain tumor – An unresolved issue

Cited by 19 publications

References 52 publications

High Incidence of Intracerebral Hemorrhaging Associated with the Application of Low-Intensity Focused Ultrasound Following Acute Cerebrovascular Injury by Intracortical Injection

High Incidence of Intracerebral Hemorrhaging Associated with the Application of Low-Intensity Focused Ultrasound Following Acute Cerebrovascular Injury by Intracortical Injection

Let Us Not Forget About Bleeding: A Case Report and Brief Literature Review on Hemorrhagic Vestibular Schwannoma

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

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