Learn about brain tumor or how to treat brain tumors.

Brain Tumors
Therapy of any intracranial malignancy requires both symptomatic
and definitive treatments.

Definitive treatment is based on the specific
tumor type and includes surgery, radiotherapy, and chemotherapy.
However, symptomatic treatments apply to brain tumors of any type.
Most high-grade malignancies are accompanied by substantial sur-
rounding edema, which contributes to neurologic disability and raised
intracranial pressure.

Glucocorticoids are highly effective at reducing
perilesional edema and improving neurologic function, often within
hours of administration. Dexamethasone has been the glucocorticoid
of choice because of its relatively low mineralocorticoid activity; initial
doses are 8–16 mg/d.

Glucocorticoids rapidly ameliorate symptoms
and signs, but their long-term use causes substantial toxicity including
insomnia, weight gain, diabetes mellitus, steroid myopathy, and person-
ality changes. Consequently, a taper is indicated as definitive treatment
is administered and the patient improves.

Patients with brain tumors who present with seizures require
antiepileptic drug therapy. There is no role for prophylactic antiep-
ileptic drugs in patients who have not had a seizure. The agents of
choice are those drugs that do not induce the hepatic microsomal
enzyme system.

These include levetiracetam, topiramate, lamot-
rigine, valproic acid, and lacosamide (Chap. 418). Other drugs,
such as phenytoin and carbamazepine, are used less frequently
because they are potent enzyme inducers that can interfere with
both glucocorticoid and chemotherapy metabolism. Venous throm-
boembolic disease occurs in 20–30% of patients with high-grade
gliomas or brain metastases.

Prophylactic anticoagulants should be
used during hospitalization and in nonambulatory patients. Those
who have had either a deep vein thrombosis or pulmonary embolus
can receive therapeutic doses of anticoagulation safely and without
increasing the risk for hemorrhage into the tumor. Inferior vena cava
filters are reserved for patients


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