Critical Care Management of Cerebral Edema in Brain Tumors

Esquenazi, Yoshua; Lo, Victor P.; Lee, Ki-Won

doi:10.1177/0885066615619618

Cited by 68 publications

(71 citation statements)

References 66 publications

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“…Brain tumor growth disrupts the blood-brain barrier by displacing adjacent healthy tissue and inducing vascular abnormalities, and thereby causes cerebral edema [8,9,33,35]. Since the brain is enclosed in the cranial vault, tumor growth and/or edema may cause an increase in ICP that manifests as headaches, nausea, and/or vomiting.…”

Section: Discussionmentioning

confidence: 99%

A Biomechanical Model of Tumor-induced Intracranial Pressure and Edema in Brain Tissue

Sorribes¹,

Byrne

Moore³

et al. 2018

Preprint

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Brain tumor growth and tumor-induced edema result in increased intracranial pressure (ICP), which, in turn, is responsible for conditions as benign as headaches and vomiting, or as severe as seizures, neurological damage, or even death. Therefore, it has been hypothesized that tracking ICP dynamics may offer improved prognostic potential in terms of early detection of brain cancer and better delimitation of the tumor boundary. However, translating such theory into clinical practice remains a challenge, in part, due to an incomplete understanding of how ICP correlates with tumor grade. Here, we propose a multiphase mixture model that describes the biomechanical response of healthy brain tissue -in terms of changes in ICP and edema -to a growing tumor. The model captures ICP dynamics within the diseased brain and accounts for the ability/inability of healthy tissue to compensate for this pressure. We propose parameter regimes that distinguish brain tumors by grade thereby providing critical insight into how ICP dynamics vary by severity of disease. In particular, we offer an explanation for clinically observed phenomena such as lack of symptoms in low grade glioma patients versus a rapid onset of symptoms in those with malignant tumors. Our model also takes into account the effects tumor-derived proteases may have on ICP levels and extent of tumor invasion. This work represents an important first step towards understanding the mechanisms that underlie the onset of edema and ICP in cancer-afflicted brains. Continued modeling effort in this direction has the potential to make an impact in the field of brain cancer diagnostics.

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Section: Discussionmentioning

confidence: 99%

A Biomechanical Model of Tumor-induced Intracranial Pressure and Edema in Brain Tissue

Sorribes¹,

Byrne

Moore³

et al. 2018

Preprint

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show abstract

“…Signs of increased cranial pressure were defined as the presence of ≥1 of the following: headache, nausea, or emesis as published previously. [15][16][17] Neuropsychological symptoms were defined as memory disorder, cognitive impairment, or organic brain disorder. In the event of memory problems or episodes of forgetfulness at the time of diagnosis of BM, symptoms were summarized as memory disorders.…”

Section: Evaluation Of Neurological Symptomsmentioning

confidence: 99%

“…, only a numerical association was present because symptomatic patients in the DS-GPA class I category presented with a median OS of 18 months (range,[14][15][16][17][18][19][20][21][22] …”

mentioning

confidence: 99%

Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non–small cell lung cancer brain metastases

Steindl

Yadavalli

Gruber

et al. 2020

Cancer

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Background Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM. Methods Patients with newly diagnosed BM from non–small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM. Results A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis‐specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33‐1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23‐1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM. Conclusions Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non–small cell lung cancer. Lay Summary Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real‐life cohort of patients with BM from non–small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non–small cell lung cancer.

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“…Increased intracranial pressure (ICP) generally occurs in patients with brain tumor because of tumor-associated brain edema, tumor per se, or tumor bleeding [1]. Peritumoral edema is a leading cause of morbidity and mortality in patients with brain tumors [2].…”

Section: Introductionmentioning

confidence: 99%

Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery

Ryu¹,

Jung²,

Jung³

et al. 2019

PLoS ONE

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After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors ( p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788–59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664–52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.

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Critical Care Management of Cerebral Edema in Brain Tumors

Cited by 68 publications

References 66 publications

A Biomechanical Model of Tumor-induced Intracranial Pressure and Edema in Brain Tissue

A Biomechanical Model of Tumor-induced Intracranial Pressure and Edema in Brain Tissue

Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non–small cell lung cancer brain metastases

Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery

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