Article: PDF OnlyWhittle Ian R.Neurosurgery Quarterly: September 1992 - p 174-198 Buy Abstract Summary Intracranial neoplasms induce changes in the extracellular space and cellular components of peritumoural brain. There are also changes in craniospinal pressure dynamics, cerebral blood flow regulation, and both local and distant brain metabolism (cerebral diaschisis). The extent of these changes and presence of brain parenchymal infiltration and destruction is determined by tumour type. Perturbations in peritumoural anatomical and functional integrity can be assessed by computerised tomography (CT), magnetic resonance (MR), and positron emission tomography imaging and MR-spectroscopy. Clinical peritumoural brain dysfunction may be manifested by acute neurological icti. such as epilepsy, or progressive neurological deficits. From the anatomicofunctional viewpoint there is often a dichotomy between clinical dysfunction and neuroradiological (CT and MR imaging) findings. Some of this paradox is related to the biology of the tumour neuropathology but the relationships between peritumoural brain dysfunction and anatomical, metabolic, and physiological changes remain unclear. The basis of clinical improvement after glucocorticoid and surgical therapies is multifactorial and will become more clearly understood with the application of functional imaging techniques. Although experimental models of glioma have limitations, they may provide insights into aspects of peritumoural brain dysfunction and novel approaches to therapy. © Williams & Wilkins 1992. All Rights Reserved.