Peritumoral Edema in Gliomas: A Review of Mechanisms and Management

Abstract

Treating malignant glioma is challenging owing to its highly invasive potential in healthy brain tissue and the formation of intense surrounding edema. Peritumoral edema in gliomas can lead to severe symptoms including neurological dysfunction and brain herniation. For the past 50 years, the standard treatment for peritumoral edema has been steroid therapy. However, the discovery of cerebral lymphatic vessels a decade ago prompted a re-evaluation of the mechanisms involved in brain fluid regulation and the formation of cerebral edema. This review aimed to describe the clinical features of peritumoral edema in gliomas. The mechanisms currently known to cause glioma-related edema are summarized, the limitations in current cerebral edema therapies are discussed, and the prospects for future cerebral edema therapies are presented. Further research concerning edema surrounding gliomas is needed to enhance patient prognosis and improve treatment efficacy.

Different Effects of Phototherapy for Rat Glioma during Sleep and Wakefulness

“…New therapeutic strategies targeting BD and the MLV functions appear to be promising [16][17][18]. The re-discovery of MLVs prompted a re-evaluation of the mechanisms responsible for regulation of BD and the formation of cerebral edema in gliomas [16][17][18]34]. In our series of experiments, for the first time, we clearly demonstrated that PBM stimulates BD in both healthy rodents and rats with glioma [24][25][26][27][28].…”

Impact of glioma peritumoral edema, tumor size, and tumor location on alternating electric fields (AEF) therapy in realistic 3D rat glioma models: a computational study

“…TTFields-enhancing techniques such as skull remodeling (Korshoej et al 2016, Mikic et al 2021 might help to compensate for the field strength loss caused by the peritumoral edema. Beyond the stifling effects of peritumoral edema on the efficacy of AEF, the edema has other clinically-relevant implications including promoting GBM cell infiltration (Ohmura et al 2023), which has been found to be associated with GBM recurrence/progression (Qin et al 2021). Electrets are inorganic or macromolecular permanently-polarized agents that can provide endogenous electrical stimulation upon application of an external electric field (Grier 2001, Zhang et al 2023, and future pre-clinical research may consider using electrets to modify the electrical properties (e.g.…”

Homeostatic status of thyroid hormones and brain water movement as determinant factors in biology of cerebral gliomas: a pilot study using a bioinformatics approach

“…Some current studies have highlighted the regulatory function of AQPs on brain volume in many other neurological diseases besides tumors ( Sun et al, 2022 ; Ohmura et al, 2023 ). In gliomas, both AQP1 and AQP4, when suppressed, offer a better prognosis for patients affected by these types of tumors by edema reduction ( Faraj et al, 2022 ; Ohmura et al, 2023 ), facilitating the management of neurological deficits in the pre-and postoperative periods, with peritumoral edema being more relevant, in terms of concerns the aggressiveness of this cancer, rather than its extent, per se ( Faraj et al, 2022 ). AQP1, for example, is upregulated in the peritumoral area, especially in the vessels surrounding reactive astrocytes in high-grade gliomas.…”