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Management of vasogenic edema in patients with primary and metastatic brain tumors

Jan Drappatz, MD
Patrick Y Wen, MD
Section Editor
Lisa M DeAngelis, MD, FAAN, FANA
Deputy Editor
April F Eichler, MD, MPH


The vasogenic edema that surrounds many brain tumors contributes significantly to morbidity. This edema results from disruption of the blood brain barrier, allowing protein-rich fluid to accumulate in the extracellular space [1].

The pathogenesis of peritumoral vasogenic edema and the use of glucocorticoids are reviewed here. The acute treatment of elevated intracranial pressure (ICP) is discussed elsewhere. (See "Evaluation and management of elevated intracranial pressure in adults", section on 'General management' and "Evaluation and management of elevated intracranial pressure in adults", section on 'Specific therapies'.)


Tumor-related disruption in the blood brain barrier is caused by two major mechanisms:

The local production of factors that increase the permeability of tumor vessels such as vascular endothelial growth factor (VEGF) [2], glutamate [3], and leukotrienes [4].

The absence of tight endothelial cell junctions in tumor blood vessels. These vessels develop in response to angiogenic factors such as VEGF [2] and basic fibroblast growth factor (bFGF, FGF - 2) [5].

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2016.
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