[Neuroprotection in brain tumors. Good sense or nonsense from the pathophysiological viewpoint?]

The hemodynamic and metabolic state of peritumoral brain tissue is not well understood, especially with subtotal or total, extraluminal compression of the carotid artery or other main intracranial vessels of the central nervous system. Possibly, parallels can be drawn from the knowledge in chronically malperfused brain tissue of atherosclerotic disease in sub- or nearly total stenosis of the internal carotid artery. From this point of view, it seems that the CBF/CBV quotient and oxygen extraction rate represent an additional diagnostic method-if needed in combination with the well-established balloon occlusion test-to help to better characterize the grade of still viable peritumoral brain tissue. The therapeutic strategy for possible pharmacological neuroprotection should be related to these parameters. It remains a matter of debate whether this clinical phenomenon will be one of the therapeutic domains influenced by ischemic preconditioning in the near-future.