title: Critical Care Management of Cerebral Edema in Brain Tumors.
abstract: Cerebral edema associated with brain tumors is extremely common and can occur in both primary and metastatic tumors. The edema surrounding brain tumors results from leakage of plasma across the vessel wall into the parenchyma secondary to disruption of the blood-brain barrier. The clinical signs of brain tumor edema depend on the location of the tumor as well as the extent of the edema, which often exceeds the mass effect induced by the tumor itself. Uncontrolled cerebral edema may result in increased intracranial pressure and acute herniation syndromes that can result in permanent neurological dysfunction and potentially fatal herniation. Treatment strategies for elevated intracranial pressure consist of general measures, medical interventions, and surgery. Alhough the definitive treatment for the edema may ultimately be surgical resection of the tumor, the impact of the critical care management cannot be underestimated and thus patients must be vigilantly monitored in the intensive care unit. In this review, we discuss the pathology, pathophysiology, and clinical features of patients presenting with cerebral edema. Imaging findings and treatment modalities used in the intensive care unit are also discussed.
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Yoshua
authors.initials: Y
authors.lastname: Esquenazi
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Victor P
authors.initials: VP
authors.lastname: Lo
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA Kiwon.Lee@uth.tmc.edu.
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D001812:Blood-Brain Barrier / Q000503:physiopathology; D001929:Brain Edema / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001932:Brain Neoplasms / Q000150:complications* / Q000628:therapy; D003422:Critical Care; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004677:Encephalocele / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D056888:Patient Positioning / Q000379:methods; D017410:Practice Guidelines as Topic
chemical_list: D004234:Diuretics, Osmotic
keywords: blood–brain barrier; brain tumor; cerebral edema; corticosteroids; herniation