Management of Vasogenic Edema in Brain Tumor Patients: Current and Emerging Strategies

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ID: 328531
2026
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Abstract
Abstract Vasogenic edema occurs due to a structural and functional disruption of the blood-brain barrier (BBB) and blood-tumor barrier (BTB); it is a major contributor to morbidity in patients with primary and metastatic brain tumors. Vasogenic edema is characterized by extracellular fluid accumulation due to abnormal tumor vasculature and is closely associated with higher tumor grade and more aggressive histology. Glioma-driven changes in the brain microenvironment such as VEGF-mediated angiogenesis, loss of tight junction integrity, and dysregulation of aquaporin channels promote BBB permeability, increased intracranial pressure, and neurological dysfunction. Corticosteroids are the first-line therapy for vasogenic edema and provide rapid symptomatic relief by restoring BBB stability. Side-effects and negative prognostic implications underscore the need for alternatives to steroids. Anti-VEGF agents, tyrosine kinase inhibitors, COX-2 inhibitors and experimental treatments are emerging medical strategies, but they have had variable clinical success. Osmotic agents such as mannitol and hypertonic saline remain essential for acute management of intracranial hypertension. Surgical and device-based interventions including laser interstitial thermal therapy (LITT), tumor treating fields (TTF), and focused ultrasound are promising avenues for modulating BBB permeability and improving therapeutic drug delivery. Despite expanding treatment options, targeted therapies specifically addressing vasogenic edema remain limited. This review synthesizes the current understanding of BBB/BTB pathophysiology, tumor-specific edema patterns, established clinical management strategies, and evolving therapeutic approaches aimed at improving outcomes for patients with brain tumor–associated vasogenic edema.
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Authors Venina Kalistratova, Orwa Aboud
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Journal Neuro-Oncology Practice
Year 2026
DOI
10.1093/nop/npag094
URL
https://academic.oup.com/nop/advance-article-pdf/doi/10.1093/nop/npag094/71027966/npag094.pdf
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