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

Abstract

<jats:p>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 &lt; 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 &lt; 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.</jats:p>

Peritumoral brain edema in intracranial meningiomas

“…9,10 However, more recent reports have demonstrated such a relationship. 6,7,10,11 In these reports, the meningothelial subtype was associated with PTBE more often than fibroblastic subtypes. In 1992, Inamura et al reported that meningothelial and transitional meningiomas tended to be associated with a larger area of PTBE than fibroblastic meningiomas.…”

“…2 Although previous reports have found no relationship between tumor size and PTBE, as was the case in our study, 9,22 some authors have reported that larger tumor volume is related to the incidence of PTBE. 3,[5][6][7][8]11,14 Several authors have reported that frontal sphenoid ridge meningiomas are associated with increased PTBE in comparison with those in other areas. 22,24 This is contrary to our results.…”

“…Perioperative mortality and morbidity may increase due to PTBE in meningioma. 2 Many factors, including tumor size, [3][4][5][6][7][8] histological subtype, 6,7,9,10 vascularity, 11,12 secretory activity, 13 tumor related venous obstruction, 3 expression of sex hormones and receptors, 5,14,15 have been considered to be related to PTBE but none has proved to be a definite cause.…”

Alterations in diffusion and perfusion in the pathogenesis of peritumoral brain edema in meningiomas

“…Meningiomas with a blood supply of exclusively dural origin are typically free from edema, whereas communication between the tumoral blood supply and the cerebral circulation is generally accompanied by the development of edema [44]. A connection between the tumoral blood supply and the cerebral circulation demonstrates the close morphological relationship of the tumor surface and the adjacent brain tissue.…”

“…Moreover, changes in the arterial blood supply of tumors indicate the significance of the brain-tumor interface [41,44]. Meningiomas with a blood supply of exclusively dural origin are typically free from edema, whereas communication between the tumoral blood supply and the cerebral circulation is generally accompanied by the development of edema [44].…”