Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence

Simis, André; Aguiar, Paulo Henrique Pires de; Leite, Claudia da Costa; Santana, Pedro; Rosemberg, Sérgio; Teixeira, Manoel Jacobsen

doi:10.1016/j.surneu.2008.03.006

Cited by 92 publications

(72 citation statements)

References 39 publications

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“…7,17,18,21 Peritumoral edema associated with parasagittal or parafalcine meningiomas is common, with some series showing edema in 48% of patients. 17 At times, the edema may be symptomatic and necessitate medical therapy such as steroids to lessen or relieve symptoms.…”

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confidence: 99%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

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confidence: 99%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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“…3,4,15 Other factors associated with PTBE include histological subtype, increased tumor size, irregular margins, pial cortical blood supply, location at the midline 10 or frontal skull base, 17 and poor basal venous drainage. 11,18,19,21 The physiological basis for meningioma-associated cerebral edema is attributed to blood-brain barrier breakdown. Biological factors such as expression of VEGF, matrix metalloproteinase-9, 16 and interleukin-6 17 trend toward an increase in PTBE.…”

Section: Discussionmentioning

confidence: 99%

The lion's mane sign: surgical results using the bilateral fronto-orbito-nasal approach in large and giant anterior skull base meningiomas

Li¹,

Portman²,

Rahal

et al. 2014

JNS

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Object. Concerns about extreme peritumoral edema and its ensuing surgical and perioperative complications led the authors to use the bilateral fronto-orbito-nasal approach to remove midline anterior skull base meningiomas that were larger than 4 cm. The authors hypothesize that extreme vasogenic edema exemplified by finger-like hyperintensities extending into the bifrontal white matter and external capsule and/or the extreme capsule, coined the lion's mane sign (LMS), would help identify patients with a challenging postoperative course. They hypothesize that the LMS would better predict symptomatic postoperative cerebral edema than the edema index (EI).Methods. This is an observational case series of 9 patients. The authors noted the grade, pathology, tumor volume, EI, and the presence or absence of the LMS in all tumors. They used the intensive unit care (ICU) length of stay as a nonspecific measure reflecting postoperative symptomatic cerebral edema. Comparisons of edema-related postoperative complications and the EI were made between patients with and without an LMS.Results. Bifrontal hyperintensities, extending into at least three-eighths of the length of the external capsules on T2-weighted MRI, seen in 4 of 9 patients, portended a longer postoperative ICU stay. The presence of an LMS better predicted postoperative complications related to cerebral edema than tumor grade, pathology, volume, or EI.Conclusions. The LMS predicts an increased duration of stay in the ICU after a bilateral fronto-orbito-nasal approach for resection of large and giant anterior skull base meningiomas. Furthermore, the LMS better predicted increased length of stay in the ICU than did the EI. (http://thejns.org/doi/abs/10.3171/2013.11.JNS13552) key WorDS • lion's mane sign • peritumoral brain edema • edema index • oncology 315Abbreviations used in this paper: EI = edema index; ICU = intensive care unit; LMS = lion's mane sign; LOS = length of stay; PONES = postoperative nonconvulsive encephalopathic status; PTBE = peritumoral brain edema.

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“…Invasive meningiomas disrupt structural integrity of the arachnoid and pia mater, which is followed by disintegration of the cortical layer and glial matrix [12][13][14]. It facilitates excretory-secretory phenomena with direct influence of the tumor metabolites on the adjacent brain parenchyma, results in development of pial vascular supply to the neoplasm, and alters blood-brain barrier permeability with typical formation of the vasogenic brain edema [15][16][17][18][19][20]. Invasive growth and prominent peritumoral edema are more frequently observed in larger tumors with greater compressive effect on the adjacent cerebral structures [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…It facilitates excretory-secretory phenomena with direct influence of the tumor metabolites on the adjacent brain parenchyma, results in development of pial vascular supply to the neoplasm, and alters blood-brain barrier permeability with typical formation of the vasogenic brain edema [15][16][17][18][19][20]. Invasive growth and prominent peritumoral edema are more frequently observed in larger tumors with greater compressive effect on the adjacent cerebral structures [18][19][20]. Peritumoral alterations of the cerebral blood flow with or without ischemia caused by mass-effect of the neoplasm and accumulation of the edematous fluid are not uncommon in cases of intracranial meningiomas [21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Metabolic alterations in the peritumoral brain in cases of meningiomas: 1H-MRS study

Chernov

Nakaya

Kasuya

et al. 2009

Journal of the Neurological Sciences

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Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence

Cited by 92 publications

References 39 publications

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

The lion's mane sign: surgical results using the bilateral fronto-orbito-nasal approach in large and giant anterior skull base meningiomas

Metabolic alterations in the peritumoral brain in cases of meningiomas: 1H-MRS study

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