The management of brain edema in brain tumors.
This review focuses on pathophysiology, clinical signs, and imaging of brain edema associated with intracranial tumors and its treatment. Brain edema in brain tumors is the result of leakage of plasma into the parenchyma through dysfunctional cerebral capillaries. The latter type of edema (ie, vasogenic edema) and the role of other types in brain tumors is discussed. Vascular endothelial growth factor-induced dysfunction of tight junction proteins probably plays an important role in the formation of edema. Corticosteroids are the mainstay of treatment of brain edema. When possible, corticosteroids should be used in a low dose (eg, 4 mg dexamethasone daily) to avoid serious side effects such as myopathy or diabetes. Higher doses of dexamethasone (16 mg/day or more), sometimes together with osmotherapy (mannitol, glycerol) or surgery, may be used in emergency situations. On tapering, one should be aware of the possible development of corticosteroid dependency or withdrawal effects.Novel therapies include vascular endothelial growth factor receptor inhibitors and corticotropin releasing factor, which should undergo further clinical testing before they can be recommended in practice.
Kaal
Evert C A
EC
Department of Neurology, Medical Centre Haaglanden, 2502 CK The Hague, The Netherlands.
Vecht
Charles J
CJ
D001812:Blood-Brain Barrier / Q000503:physiopathology; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001932:Brain Neoplasms / Q000150:complications*; D003907:Dexamethasone / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014882:Water-Electrolyte Balance
D003907:Dexamethasone