[Two cases of an intracranial large hemangiopericytoma associated with brain swelling in the early operative stage].
Intracranial hemangiopericytomas are hypervascular tumors. Consequently, resection of these tumors must occasionally be stopped owing to profuse bleeding. We report two cases of large intracranial hemangiopericytoma whose resection had to be stopped owing not to bleeding but to brain swelling. These patients were treated with large doses of barbiturate until the intracranial pressure had normalized. After preoperative irradiation therapy, the residual tumors were easily removed without serious complications. We speculate that the brain tissue around a large hemangiopericytoma might be under ischemia because of long-standing compression and deviation of blood to the hypervascular tumor. A large amount of blood flowing into these brain tissues due to external and internal decompression inverts cerebral perfusion acutely from ischemia to hyperemia. The brain swelling in the early operative stage would be evoked by this "inverted cerebral hyperemia". We found that brain swelling is sometimes encountered during the resection of a large hemangiopericytoma even in the early operative stage. If swelling occurs, tumor resection should be stopped immediately and intracranial pressure should be controlled. The residual tumor can then be easily removed without complications after preoperative irradiation therapy.
Suyama
D
D
Department of Neurosurgery, Jikei University School of Medicine, Japan.
Sakai
H
H
Kitajima
T
T
Kamikubo
T
T
Shimizu
J
J
Abe
T
T
D000328:Adult; D001463:Barbiturates / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016371:Cranial Irradiation; D005260:Female; D006393:Hemangiopericytoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011300:Preoperative Care
D001463:Barbiturates; C032232:barbituric acid