TY - JOUR
T1 - The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema
T2 - A report of three cases
AU - Stefini, Roberto
AU - Peron, Stefano
AU - Lacamera, Alessandro
AU - Cividini, Andrea
AU - Fiaschi, Pietro
AU - Sicuri, Giovanni Marco
N1 - Publisher Copyright:
© 2021 Published by Scientific Scholar on behalf of Surgical Neurology International.
PY - 2021
Y1 - 2021
N2 - Background: Peritumoral brain edema is an uncommon but life-threatening side effect of brain tumors radiosurgery. Medical therapy usually alleviates symptoms until edema spontaneously disappears. However, when peritumoral brain edema endangers the patient's life or medical therapy fails to guarantee an acceptable quality of life, surgery might be considered. Case Description: Our report focuses on three patients who developed extensive peritumoral brain edema after radiosurgery. Two were affected by vestibular schwannomas and one by a skull-base meningioma. Peritumoral brain edema worsened despite maximal medical therapy in all cases; therefore, surgical removal of the radiated lesion was carried out. In the first patient, surgery was overdue and resulted in a fatal outcome. On the other hand, in the latter two cases surgery was quickly effective. In all three cases, an unmanageable brain swelling was not found at surgery. Conclusion: Surgical removal of brain tumors previously treated with radiosurgery was safe and effective in resolving shortly peritumoral brain edema. This solution should be considered in patients who do not respond to medical therapy and before worsening of clinical conditions. Interestingly, the expected brain swelling was not confirmed intraoperatively. In our experience, this magnetic resonance finding should not be considered a criterion to delay surgery.
AB - Background: Peritumoral brain edema is an uncommon but life-threatening side effect of brain tumors radiosurgery. Medical therapy usually alleviates symptoms until edema spontaneously disappears. However, when peritumoral brain edema endangers the patient's life or medical therapy fails to guarantee an acceptable quality of life, surgery might be considered. Case Description: Our report focuses on three patients who developed extensive peritumoral brain edema after radiosurgery. Two were affected by vestibular schwannomas and one by a skull-base meningioma. Peritumoral brain edema worsened despite maximal medical therapy in all cases; therefore, surgical removal of the radiated lesion was carried out. In the first patient, surgery was overdue and resulted in a fatal outcome. On the other hand, in the latter two cases surgery was quickly effective. In all three cases, an unmanageable brain swelling was not found at surgery. Conclusion: Surgical removal of brain tumors previously treated with radiosurgery was safe and effective in resolving shortly peritumoral brain edema. This solution should be considered in patients who do not respond to medical therapy and before worsening of clinical conditions. Interestingly, the expected brain swelling was not confirmed intraoperatively. In our experience, this magnetic resonance finding should not be considered a criterion to delay surgery.
KW - Brain swelling
KW - Meningioma
KW - Peritumoral brain edema
KW - Radiosurgery
KW - Vestibular schwannoma
UR - http://www.scopus.com/inward/record.url?scp=85111205868&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111205868&partnerID=8YFLogxK
U2 - 10.25259/SNI_111_2021
DO - 10.25259/SNI_111_2021
M3 - Article
AN - SCOPUS:85111205868
VL - 12
JO - Surgical Neurology International
JF - Surgical Neurology International
SN - 2152-7806
M1 - A5
ER -