Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

Gempt, Jens; Gerhardt, Julia; Tóth, Vivien; Hüttinger, Stefanie; Ryang, Yu‐Mi; Wostrack, Maria; Krieg, Sandro M.; Förschler, Annette; Ringel, Florian

doi:10.3171/2013.9.jns13596

Cited by 29 publications

(21 citation statements)

References 27 publications

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“…Our sample size was determined to evaluate this endpoint, which proved to be significant but too small to determine whether the association between rIPC and infarct volume is significant as well. In addition, infarct volumes were generally small in both groups, which is consistent with the results of previous studies [16, 18]. However, we found a trend toward smaller infarct volumes in the rIPC group.…”

Section: Discussionsupporting

confidence: 93%

“…Consequently, surgical resection of brain metastases is often considered easier and less damaging to the surrounding brain tissue than the resection of glial tumors [22]. Previous studies have demonstrated differences in incidence of new postoperative ischemic lesions between these two entities [16, 17]. A retrospective study involving 122 patients with brain metastases showed that 44 patients (36.1%) had postoperative ischemic lesions, whereas another retrospective study involving glioma patients showed an incidence of 31% (26 of 84 patients) of postoperative ischemic lesions in patients with newly diagnosed gliomas and 80% (20 of 25 patients) in patients with recurrent gliomas [16, 17].…”

Section: Discussionmentioning

confidence: 99%

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Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial

Sales

Barz

Bette

et al. 2017

BMC Med

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BackgroundPostoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences.MethodsSixty patients were randomly assigned to two groups, with 1:1 allocation, stratified by tumor type (glioma or metastasis) and previous treatment with radiotherapy. rIPC was induced by inflating a blood pressure cuff placed on the upper arm three times for 5 min at 200 mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the control group no preconditioning was performed. Early postoperative magnetic resonance images (within 72 h after surgery) were evaluated by a neuroradiologist blinded to randomization for the presence of ischemia and its volume.ResultsFifty-eight of the 60 patients were assessed for occurrence of postoperative ischemia. Of these 58 patients, 44 had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (27/31) than in the rIPC group (17/27) (p = 0.03). The median infarct volume was 0.36 cm3 (interquartile range (IR): 0.0–2.35) in the rIPC group compared with 1.30 cm3 (IR: 0.29–3.66) in the control group (p = 0.09).ConclusionsApplication of rIPC was associated with reduced incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery. This is the first study indicating a benefit of rIPC in brain tumor surgery.Trial registrationGerman Clinical Trials Register, DRKS00010409. Retrospectively registered on 13 October 2016.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial

Sales

Barz

Bette

et al. 2017

BMC Med

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“…Since areas around the resection cavity become ischemic after metastasis resection, 85 and residual GB cells are invariably found within 1-2 cm of an ischemic resection perimeter, these isolated pioneer cells hijack elements of the healing response, in particular G(M)-CSF increased by surgical brain tissue injury, to promote their growth in peri-resection tissue. 18 Repurposed drugs reviewed in this paper, fenofibrate, ribavirin, and dapsone, have shown ability to reduce G(M)-CSF levels or consequences of G(M)-CSF (see Table 2 for an overview).…”

Section: G(m)-csf Is a Direct Growth Factor For Gbmentioning

confidence: 99%

Glioblastoma-synthesized G-CSF and GM-CSF contribute to growth and immunosuppression: Potential therapeutic benefit from dapsone, fenofibrate, and ribavirin

Kast¹,

Hill

Wion

et al. 2017

Tumour Biol.

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Increased ratio of circulating neutrophils to lymphocytes is a common finding in glioblastoma and other cancers. Data reviewed establish that any damage to brain tissue tends to cause an increase in G-CSF and/or GM-CSF (G(M)-CSF) synthesized by the brain. Glioblastoma cells themselves also synthesize G(M)-CSF. G(M)-CSF synthesized by brain due to damage by a growing tumor and by the tumor itself stimulates bone marrow to shift hematopoiesis toward granulocytic lineages away from lymphocytic lineages. This shift is immunosuppressive and generates the relative lymphopenia characteristic of glioblastoma. Any trauma to brain-be it blunt, sharp, ischemic, infectious, cytotoxic, tumor encroachment, or radiation-increases brain synthesis of G(M)-CSF. G(M)-CSF are growth and motility enhancing factors for glioblastomas. High levels of G(M)-CSF contribute to the characteristic neutrophilia and lymphopenia of glioblastoma. Hematopoietic bone marrow becomes entrained with, directed by, and contributes to glioblastoma pathology. The antibiotic dapsone, the lipid-lowering agent fenofibrate, and the antiviral drug ribavirin are Food and Drug Administration-and European Medicines Agency-approved medicines that have potential to lower synthesis or effects of G(M)-CSF and thus deprive a glioblastoma of some of the growth promoting contributions of bone marrow and G(M)-CSF.

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“…To avoid misinterpretation due to bleeding in the resection cavity, T1-weighted images without contrast agent are important for differentiation and are also routinely used in brain tumor imaging [19]. Moreover, postoperative infarction is observed after surgery of brain metastases and may cause a bias of the FLAIR signal increase [20]. However, vasogenic edema due to infarction is observed mainly in the first days after surgery and these images were excluded from analysis.…”

Section: Discussionmentioning

confidence: 99%

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

Bette

Gempt

Wiestler

et al. 2016

Fortschr Röntgenstr

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Results 3 of 6 cases with local tumor recurrence showed a FLAIR signal increase (sensitivity 50.0 %, specificity 100.0 %). In one case, this sign was observed even about 3 months before tumor recurrence.The specificity of FLAIR signal increase for overall tumor recurrence (local and distant) was also 100.0 %, but with a lower sensitivity of 13.0 %.Quantitative analysis showed significant differences for signal intensity of the resection cavity as well as for the change of signal intensity of the resection cavity in cases with or without local tumor recurrence.Conclusion An increase in FLAIR signal of the fluid within the resection cavity might be a highly specific and early sign of local tumor recurrence/tumor progression also for brain metastases. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.Key points: ▪ An increase in FLAIR signal intensity of the fluid within the resection cavity is also observed in previously resected brain metastases. ▪ The pathophysiology of this sign might be due to a cell-proliferative process.

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Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

Cited by 29 publications

References 27 publications

Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial

Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial

Glioblastoma-synthesized G-CSF and GM-CSF contribute to growth and immunosuppression: Potential therapeutic benefit from dapsone, fenofibrate, and ribavirin

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

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