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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Bi-Directional capillary permeability, regional blood volume and size of the extracellular space in brain metastases – Implications for treatment

Bi-direktionale kapilläre Permeabilität, regionales Blutvolumen und Größe des Extrazellulärraumes in Hirnmetastasen - Implikationen für die Therapie

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  • corresponding author Peter-Christian Warnke - Department of Neurosurgery, The University of Liverpool, The Walton Centre of Neurology and Neurosurgery, Lower Lane, Liverpool /UK; Abt. Stereotaktische Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • K. Kopitzki - Department of Neurosurgery, The University of Liverpool, The Walton Centre of Neurology and Neurosurgery, Lower Lane, Liverpool /UK; Abt. Stereotaktische Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • F. J. Hans - Department of Neurosurgery, The University of Liverpool, The Walton Centre of Neurology and Neurosurgery, Lower Lane, Liverpool /UK; Abt. Stereotaktische Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • J. Timmer - Department of Neurosurgery, The University of Liverpool, The Walton Centre of Neurology and Neurosurgery, Lower Lane, Liverpool /UK; Abt. Stereotaktische Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
  • C. B. Ostertag - Department of Neurosurgery, The University of Liverpool, The Walton Centre of Neurology and Neurosurgery, Lower Lane, Liverpool /UK; Abt. Stereotaktische Neurochirurgie, Universitätsklinikum Freiburg, Freiburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.04.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0179.shtml

Published: April 23, 2004

© 2004 Warnke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

Cerebral metastases pose a therapeutic challenge as their vascular physiology limits the efficacy of chemotherapy and immunotherapy. We have therefore performed a quantitative study into the physiology of metastatic vasculature.

Methods

Seven patients underwent measurement of the blood-brain transfer rate (K1) the brain-blood transfer rate (K2), the plasma vascular space and the extracellular space using dynamic spiral-CT. From these measurements parameter maps with a spatial resolution of .8 x .8 x 400ml were derived and histogram analysis was performed as to the distribution of physiological variables within the tumour and surrounding brain.

Results

Mean value for the blood-brain transport were 13.98 ± 7.16 μl/gm/min with a variation from 3.1 ± 9.4 to 25.5 ± 17.9. Vascular space showed a mean of .038 ± .024 μl/gm with a variation of .015 ± .025 to .075 ± .008 ml/gm. Also the efflux constant (K2) varied considerably with a median of 59 ± 45.6 min. The extracellular space was extremely variable ranging from .13 to .7 ml/gm with a mean of .38 ± .012. There was no correlation between vascularisation and individual tumour permeability (logistic regression p>.05). Metastases were significantly less permeable than primary CNS lymphomas (p<.01).

Conclusions

Our study shows that cerebral metastases are a heterogeneous physiological entity with severely limited permeability for water-soluble drugs making them rather distinct from other extra cerebral tumours like CNS lymphomas. Also the extracellular space in these tumours is quite enlarged resulting in a ‘sink effect’ for any drug penetrating into the extracellular space of the tumour.