Transient Cerebral Edema Research Articles

STMO-01 Cerebral edema and perioperative epilepsy due to placement of BCNU wafer for malignant glioma

Introduction: Cerebral edema is the most frequent adverse event of BCNU wafer, which is used as local chemotherapy of malignant glioma. However, predictive factor of this event is unknown. Moreover, there is no consensus about cerebral edema and perioperative seizure, which is often observed in glioma. Here, we report risk factor of cerebral edema with BCNU placement and relationship with perioperative seizure in malignant glioma cases.Material and Method: Thirty-one case of adult malignant glioma who underwent BCNU placement in our institute between March 2013 to March 2019 were investigated. The patients were dichotomized to two groups; patient with postoperative transient cerebral edema (CE+ group) and patient without postoperative transient cerebral edema (CE- group).Result: Postoperative cerebral edema associated with placement of BCNU was observed in 9 out of 31 patients (29%). Tumor malignancy was significant parameter for postoperative cerebral edema (p=0.003). Other factors such as, age, gender, laterality, tumor location, primary or recurrent, number of BCNU wafers, duration of recurrence were not significant for postoperative cerebral edema. Seizure was seen in 14 patients (45%), and cerebral edema was not significant parameter for seizure. Tumor malignancy was significant parameters for postoperative cerebral edema. Tumor malignancy was significant parameters for seizure (p=0.0004). Although postoperative seizure was observed in 4 patients (44%) with CE+ group, neither maximum volume (mean 61.1 ml) nor change ratio (mean 354%) of FLAIR-high-intensity region were not related with postoperative seizure.Conclusions: Tumor malignancy was important factor for patients who underwent placement of BCNU wafer with postoperative cerebral edema and seizure. On the other hand, there were no relationship between postoperative cerebral edema and perioperative seizure in patients treated with BCNU wafer.

Critical Illness Secondary to Synthetic Cannabinoid Ingestion

Synthetic cannabinoids (SCs), commonly known as K2, spice, or fake weed, are cheap, artificially manufactured recreational drugs that have emerged as a major public health threat in various regions of the US. To describe the clinical manifestations of SC intoxication. This case series assessed adults admitted to the intensive care unit from 2014 to 2016 with acute life-threatening complications of SC use. Data analysis was completed in October 2016. Use of SCs such as K2, spice, or other synthetic versions of cannabinoids. Data collected included patient demographic data, medical history, presenting symptoms, physical findings, laboratory and imaging data, and intensive care unit and hospital course. Thirty patients (mean age, 41 years [range, 21-59 years]; 24 men [80%]) with SC ingestion were admitted to the intensive care unit over a 2-year period. Thirteen patients were undomiciled. The majority had a history of polysubstance abuse, psychiatric illness, or personality disorder. The admission diagnoses were coma (10 patients [33%]), agitation (10 patients [33%]), and seizure (6 patients [20%]). Eighteen patients (60%) had acute respiratory failure, and tracheal intubation was required in 21 patients (70%) for either airway protection or acute respiratory failure. Rhabdomyolysis was noted in 8 patients (26%). A man developed transient cerebral edema with loss of gray-white differentiation but had complete recovery. A woman with history of asthma died of acute respiratory distress syndrome. All patients underwent routine toxicology testing, which was unrevealing in 16 cases and revealed coingestion in the remainder. Sixteen patients (53%) left the hospital against medical advice. Ingestion of SCs can lead to life-threatening complications, including severe toxic encephalopathy, acute respiratory failure, and death. Synthetic cannabinoids are undetectable in routine serum and urine toxicology testing but can be suspected on the basis of history and clinical presentation, which may include extreme agitation or coma. Frontline clinicians must be aware of the presentation and be vigilant in suspecting SC intoxication.

Vasogenic Brain Edema During Maintenance Hemodialysis : Preliminary Results from Tract-based Spatial Statistics and Voxel-based Morphometry.

Hemodialysis (HD), especially when first initiated, can cause neurological deterioration. Presumably this is due to transient cerebral edema, which has been observed using diffusion weighted magnetic resonance imaging (MRI) in experimental and human studies; however, this has not been investigated under maintenance hemodialysis (mHD). Moreover, there are no studies to date investigating regional effects of mHD on grey and white matter volumes. In this study eight patients with end stage renal disease (ESRD) were examined immediately before and after mHD sessions with multimodal MRI, including diffusion tensor imaging (DTI) and high-resolution structural imaging. Additionally, eight healthy, age-matched and sex-matched controls were examined for comparison. Data were analyzed using tract-based spatial statistics and voxel-based morphometry. At baseline, ESRD patients had significantly reduced values of fractional anisotropy (FA) and axial diffusivity as well as bilaterally reduced grey matter volume in the insula, compared with controls. After the mHD session, FA further decreased while axial, radial, and mean diffusivity significantly increased ubiquitously throughout the white matter. Voxel-based morphometry revealed acorresponding significant increase in white matter volume in the central right hemisphere and splenium, as well as in cortical grey matter in the anterior medial frontal and cingulate cortex. None of the patients showed neurological deterioration. In this study ESRD patients showed white matter changes indicative of chronic microstructural damage when compared with healthy controls, as previously reported. In addition, patients showed signs of atransient extracellular cerebral edema, which has not yet been observed in the absence of neurological symptoms.

RADIOCHIRURGIA STEREOTACTICĂ GAMMA KNIFE (RGK) ÎN TRATAREA MENINGIOAMELOR – STUDIU PE 550 DE PACIENŢI

Introduction. Meningiomas are benign tumors which originate from the cells of the arachnoid granules. Meningiomas represent a special pathologic entity for neurosurgeons due to the fact that they can grow silently for a long time, and can affect important neural structures when they become symptomatic. The total resection of meningiomas is curative. For the meningiomas which are not surgically accessible and for reoccurrence. Gamma Knife radiosurgery (GKS) is a very efficient solution. Materials and methods. The study below presents the experience of the authors regarding the use of GKS for the treatment of meningiomas. The authors focus on a population of 550 patients diagnosed and treated for meningiomas over a period of 10 years at the „Bagdasar-Arseni“ University Hospital in Bucharest. This study compares the impact of GKS when performed alone or in association with open microneurosurgery. The authors assessed patients with tumors ranging between 1 and 42 cm3 in volume. GKS is used successfully to treat meningiomas, both independently and in association with open microsurgery. Results. The major complications of the treatment are represented by lack of response to treatment (7% of patients) and transient cerebral edema (22% of patients). A disturbing phenomenon happens in a few meningiomas of the convexity, with malignant edema (<1%). Conclusion. Given the multiple advantages it has, GKS is right now the tip of the spear regarding the therapeutical methods available for meningiomas. These tumors usually are benign in nature; however, a small percentage are malignant. Often, meningiomas cause no symptoms and require no immediate treatment. But the growth of benign meningiomas can cause serious problems. In some cases, such growth can be fatal. Typically, symptomatic meningiomas are treated with either radiosurgery or conventional surgery. When the tumors met in daily practice are larger than the therapeutical resources of the devices used for GKS, an open microsurgical approach may be attempted followed by stereotactic irradiation of the remnant tumor.

Motor cortex stimulation: functional magnetic resonance imaging–localized treatment for three sources of intractable facial pain

Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain.

Postoperative Gamma Knife surgery for benign meningiomas of the cranial base

The standard treatment for meningiomas is complete resection, but the proximity of skull base meningiomas to important neurovascular structures makes complete excision of the lesion difficult or impossible. The authors analyzed the mid- and long-term results obtained in patients treated with postresection Gamma Knife surgery (GKS) for residual or recurrent benign meningiomas of the cranial base. Thirty-six patients with residual or recurrent benign meningiomas of the skull base following one or more surgical procedures underwent GKS. There were 31 women and five men, ranging in age from 22 to 73 years. The median tumor volume was 4.1 ml (range 0.8-20 ml) and the median radiation dose to the tumor margin was 16 Gy (range 15-16 Gy). Patients were followed for a median of 81 months (range 30-141 months) after GKS. At the end of the follow-up period, overall neurological improvement was observed in 16 patients (44.4%), whereas the condition in 20 patients (55.6%) was unchanged. One patient suffered transient cerebral edema 6 months after GKS. Based on imaging documentation, a partial response was seen in five patients (13.9%), the disease remained stable in 30 patients (83.3%), and in one patient (2.8%) there was an increase in tumor size. The actuarial progression-free survival rate was 100% at 5 years and 94.7% at 10 years. Gamma Knife surgery was shown to be an excellent adjunct to resection because of its durable rate of tumor control and low toxicity. It should be initially considered along with surgery for the treatment of complex skull base meningiomas.

Postoperative Gamma Knife surgery for benign meningiomas of the cranial base

Object The standard treatment for meningiomas is complete resection, but the proximity of skull base meningiomas to important neurovascular structures makes complete excision of the lesion difficult or impossible. The authors analyzed the mid- and long-term results obtained in patients treated with postresection Gamma Knife surgery (GKS) for residual or recurrent benign meningiomas of the cranial base. Methods Thirty-six patients with residual or recurrent benign meningiomas of the skull base following one or more surgical procedures underwent GKS. There were 31 women and five men, ranging in age from 22 to 73 years. The median tumor volume was 4.1 ml (range 0.8–20 ml) and the median radiation dose to the tumor margin was 16 Gy (range 15–16 Gy). Results Patients were followed for a median of 81 months (range 30–141 months) after GKS. At the end of the follow-up period, overall neurological improvement was observed in 16 patients (44.4%), whereas the condition in 20 patients (55.6%) was unchanged. One patient suffered transient cerebral edema 6 months after GKS. Based on imaging documentation, a partial response was seen in five patients (13.9%), the disease remained stable in 30 patients (83.3%), and in one patient (2.8%) there was an increase in tumor size. The actuarial progression-free survival rate was 100% at 5 years and 94.7% at 10 years. Conclusions Gamma Knife surgery was shown to be an excellent adjunct to resection because of its durable rate of tumor control and low toxicity. It should be initially considered along with surgery for the treatment of complex skull base meningiomas.

Invited commentary

Invited commentary

Cranial base surgical techniques for large sphenocavernous meningiomas: technical note.

Large meningiomas arising from the dura covering the sphenoid ridge present surgical challenges because of frequent involvement of the carotid artery and its branches, the optic nerve and tract, the superior orbital fissure, and cavernous sinus structures. To circumvent the inherent difficulties of a traditional approach strategy, cranial base approaches were applied to: 1) isolate and interrupt the major blood supply as an initial step, 2) minimize brain retraction, and 3) isolate the neurovascular structures exiting the tumor at the cranial base to protect and better separate them. Six patients were treated with such a strategy in the past 2 years (five women and one man, ages 34-69 yr). All tumors measured at least 5 cm in their greatest diameter and arose at the sphenoid ridge. All tumors extended posteriorly to involve the cavernous sinus to varying degrees. In two patients a frontotemporal bone flap was used; in two patients, a transzygomatic approach was used; and in the remaining two patients, an orbitozygomatic strategy was used. Extensive bone removal at the cranial base was performed in all cases. Four patients had gross total resections, and two were subtotal owing to invasion of the cavernous sinus or the middle cerebral artery. There were no permanent cranial nerve deficits; however, two patients sustained transient IIIrd nerve paresis. Two patients postoperatively developed transient cerebral edema that required intensive treatment. All six patients had good outcomes, resuming independent activity by 3 months after surgery. Contemporary cranial base surgical techniques have a role in the treatment of large sphenoid ridge meningiomas. These strategies result in safe resection with low morbidity and obviate the need in most cases for preoperative embolization. The anatomic foundation for using these approaches is discussed.

Alterations at the Cellular Level in the Brain Following Repeated Angiography: Protective Effect of Corticosteroids

Waldron, Robert L. II, MD; Bridenbaugh, Richard B. MD; Dempsey, Edward W. PhD Author Information