Tumor-related Venous Obstruction and Development of Peritumoral Brain Edema in Meningiomas

Bitzer, Michael; Topka, Helge; Morgalla, Matthias; Friese, Siegrid; Wöckel, Lars; Voigt, Karsten

doi:10.1097/00006123-199804000-00026

Cited by 50 publications

(39 citation statements)

References 25 publications

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“…The initial volume of tumors that recurred (39 ± 45 cm 3 [SD]) was not significantly different from the volume of those that did not recur (50 ± 59 cm 3 [SD]; p = 0.35).…”

Section: Resultsmentioning

confidence: 99%

“…[22] Multiple attempts to correlate the occurrence and degree of peritumoral edema with various factors, including patient gender, tumor location, tumor size, vascularity, cellularity, mitotic activity, steroid receptors, secretory activity, blood supply by intracranial vessels, histological subtype (excepting malignant varieties), and occlusion of veins by the tumor, have failed to establish convincing relationships. [1,3,10,12,13,17,20,[24][25][26]28,30,34] Peritumoral edema has been successfully correlated with the flow cytometric proliferative index in a study of 20 tumors by Crone and coworkers [11] and in a study by Ide, et al, [19] of 57 tumors in which MIB-1 staining was used. Meningiomas with edema contained significantly higher levels of vascular endothelial growth factor messenger RNA than those without edema in 16 tumors analyzed by Kalkanis and associates [22] and in 18 tumors analyzed by Provias and colleagues.…”

Section: Discussionmentioning

confidence: 99%

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

Mantle¹,

Lach²,

Delgado³

et al. 1999

FOC

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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 years (± 4 years, standard deviation [SD]) and the mean time to recurrence was 5 years (± 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 X 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1.00, 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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“…The initial volume of tumors that recurred (39 ± 45 cm 3 [SD]) was not significantly different from the volume of those that did not recur (50 ± 59 cm 3 [SD]; p = 0.35).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mantle¹,

Lach²,

Delgado³

et al. 1999

FOC

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show abstract

“…Tamanho 6,10,11,[13][14][15][16][17][18][19][20][21] , sendo esse achado confirmado no presente estudo em que o grau de edema dos meningiomas grandes (maiores que 4 cm) foi de 2,58 ± 1,17 contra 1,64 ± 1,44 dos pequenos. Em outras séries, não foi estabelecida relação entre o tamanho dos meningiomas e edema peritumoral 12,16,19 .…”

Section: Incidência Deunclassified

“…Com relação aos subtipos histológicos, parece haver maior incidência de edema perilesional nos meningiomas malignos 10,14,18 . Os meningiomas anaplásicos têm um comportamento local agressivo, frequentemente infiltram o parênquima cerebral adjacente e quase sempre são acompanhados por um volumoso edema perilesional.…”

Section: Incidência Deunclassified

“…Bitzer e col. 14 , estudando as características angiográficas dos meningiomas, observaram que a incidência de edema não era significativamente maior na maioria dos meningiomas com sinais de invasão de seios ou compressão venosa. Estes autores consideraram que a compressão de veias de drenagem deve contribuir para a formação de edema peritumoral apenas num pequeno subgrupo de meningiomas em que há envolvimento das veias Sylvianas ou surgimento de displasias venosas na periferia dos tumores 14 . Por outro lado, a observação angiográfica de um blush tumoral desenvolvido a partir de vasos piais, com predomínio sobre os vasos nutridores meníngeos, está associado a maior incidência de edema peritumoral em meningiomas, e provavelmente contribui para a sua formação 11,13 .…”

Section: Incidência Deunclassified

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Edema cerebral em meningiomas: aspectos radiológicos e histopatológicos

Souto

Chimelli

Takya

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -Diversos fatores têm sido associados ao desenvolvimento de edema peritumoral nos meningiomas. Foram estudados os aspectos radiológicos e anátomo-patológicos de 51 meningiomas intracranianos operados no Hospital Universitário Clementino Fraga Filho (HUCFF). Dois terços dos meningiomas apresentavam edema perilesional. O tamanho dos meningiomas correlacionou-se com a presença de edema, sendo mais frequente nos meningiomas grandes (>4cm). A localização parece, também, influenciar no desenvolvimento do edema peritumoral, sendo mais acentuado nos meningiomas da asa do esfenóide e incomum nos meningiomas do tubérculo selar. Os subtipos histológicos de meningioma não se correlacionaram com a intensidade do edema peritumoral. Dos diversos mediadores químicos descritos na literatura recente relacionados ao desenvolvimento de edema peritumoral em tumores intracranianos, destaca-se o fator de crescimento do endotélio vascular (VEGF). A expressão nos meningiomas do VEGF e de seu receptor flk-1 foi estudada com técnica imunohistoquímica, demonstrando a sua expressão nas células tumorais.PALAVRAS-CHAVE: edema cerebral, meningioma, imuno-histoquímica, tomografia computadorizada, ressonância magnética. Brain edema in meningiomas: radiological and histological factorsABSTRACT -Many factors have been associated to the development of peritumoral edema in meningiomas. We studied the radiological and pathological features of 51 intracranial meningiomas surgically treated in the University Hospital of the Federal University of Rio de Janeiro. Two thirds of the meningiomas in our series had peritumoral edema. The size of the meningioma was probably related to the development of edema. Peritumoral edema was found frequently in the large meningiomas. The location of the meningioma was also associated with the frequency of peritumoral edema. Sphenoid wing meningiomas had significantly more peritumoral edema. In contrast, tuberculum sellae meningiomas were almost never associated with cerebral edema. There is growing evidence in the literature that vascular endothelial growth factor (VEGF) is a key factor in the pathogenesis of peritumoral edema. We studied by immunohistochemical techniques the expression of VEGF and its receptor flk-1 in meningiomas. Os meningiomas na sua maioria têm grande implantação dural e apresentam plano de clivagem bem definido com o parênquima cerebral adjacente, que geralmente está deslocado e comprimido. Boa parte das lesões tem crescimento lento, podendo alcançar tamanho considerável de forma assintomática, especialmente em algumas localizações, como os meningiomas originários da goteira olfativa. O comportamento biológico de cada meningioma é, entretanto, variável, principalmente quanto à capacidade de invasão dos tecidos adjacentes e produção de edema perilesional.Edema vasogênico, como definido por Klatzo (1967) 1 , é causado por aumento da permeabilidade capilar. Esse tipo de edema ocorre no tecido cerebral adjacente a uma série de neoplasias intracranianas, principalmente metástases, gliomas malign...

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Peritumoral Edema

Chang¹

2009

Meningiomas

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Tumor-related Venous Obstruction and Development of Peritumoral Brain Edema in Meningiomas

Cited by 50 publications

References 25 publications

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

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

Edema cerebral em meningiomas: aspectos radiológicos e histopatológicos

Peritumoral Edema

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