The Blood Brain Barrier, Mechanisms of Cerebral Edema, and the Use of Anti-Inflammatory and other Anti-Edema Agents in Neuro-Oncology

Vasogenic edema resultant from malignant brain and spine tumors can impart neurological disability and life threatening compression of the central nervous system. Clinical management of edema requires a working understanding of the blood brain barrier, blood cerebrospinal fluid barrier, and the major mechanisms that tumors utilize to disrupt the normal function of these barriers. Corticosteroids and anti-angiogenic agents allay vasogenic edema and serve as fundamental treatment strategies for brain and spine tumor patients. This section reviews relevant microscopic anatomy, pathologic processes and inflammatory mediators important in the production of vasogenic cerebrospinal edema, and the rationale behind management strategies of edema in this patient population.