Delayed enlargement of brain edema after resection of intracranial meningioma: two case reports.
Two patients underwent uneventful total removal of convexity or trigone meningioma, but subsequently edema enlarged causing symptoms 3-4 weeks later. Gradual improvement was obtained by steroid administration in 1 patient and re-craniotomy in 1 patient. The histological findings in Case 1 were not confirmed, but inflammatory reaction against residual microfibrillar collagen hemostat (MCH) may have developed. The specimen from around the cyst in Case 2 showed moderate staining for vascular endothelial growth factor (VEGF). VEGF secreted by the tumor might have resulted in spread of inflammation due to MCH in the brain parenchyma. Furthermore, inflammatory reactions may have obstructed or formed a one-way communication in the inferior horn and residual cavity, resulting in malabsorption of cerebrospinal fluid. Postoperative edema with the timing in these cases is difficult to anticipate. However, the risk of this phenomenon can probably be minimized by ensuring that MCH is removed as effectively as possible after use, or by refraining from use in the brain parenchyma and by taking care to connect the residual cavity to the ventricular system, particularly if the tumor contacts a cerebral ventricle.
Department of Neurosurgery, Japan Self Defense Forces Yokosuka Hospital, Yokosuka, Kanagawa, Japan. Onokeen@aol.com
Kenichiro
K
Ono
Junichi
J
Hatada
Kenzo
K
Minamimura
Ichiyo
I
Ohara
Kojiro
K
Wada
D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001929:Brain Edema / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002551:Cerebral Ventricle Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D003094:Collagen / Q000009:adverse effects; D004660:Encephalitis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D020547:Lateral Ventricles / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis / Q000378:metabolism; D055815:Young Adult
D014408:Biomarkers, Tumor; D042461:Vascular Endothelial Growth Factor A; D003094:Collagen