gms | German Medical Science

Objective: Surgical resection is an essential component of glioma treatment. The aim is maximal resection of tumor without new neurological deficits. Those deficits can be provoked by resection of eloquent tissue or by infarctions. Inclusion of diffusion weighted imaging (DWI) in the early postoperative MRI protocol improves differentiating of the origin of postoperative neurologic deficits. The present study aimed to assess the incidence of infarctions following first resection and resections of recurrent gliomas.

Methods: Between 10/08 and 01/10 80 patients with intrinsic brain tumors (50 patients WHO IV, 8 patients WHO III, 17 patients WHO II, 5 patients WHO I) received 86 early postoperative MRI (<48 h) including DWI. Sixty-nine followed a first resection, 17 a resection of recurrent tumors. Postoperative imaging was evaluated by a neuroradiologist and a neurosurgeon for areas of restricted diffusion. Those areas were classified as arterial territorial infarction, venous infarction, or terminal branch infarction, respectively.

Results: In 17 of 69 (25%) early postoperative MRI scans following first resections ischemic lesions were identified (7 arterial territorial infarctions, 6 terminal branch infarctions, 4 venous infarctions). In 10 of 16 (63%) postoperative MRI scans following resection of recurrent gliomas ischemic lesions were identified (6 arterial territorial infarction, 4 terminal branch infarction no venous infarctions). So far, only one patient who was operated on a second tumor recurrence received postoperative DWI and developed a venous infarction. Risk for infarction following glioma resection was higher in first time operated patients with high grade gliomas with 29% compared to patients with low grade gliomas with 19%.

Conclusions: In our patient cohort we revealed a higher risk for ischemic lesions after resection of high grade gliomas and of recurrent tumors. Regarding patients with recurrent gliomas, radiogenic and postoperative tissue changes could contribute to a higher risk of ischemic infarction. Comparing low grade glioma and high grade glioma the increased vascularity and changed vascular pattern of high grade gliomas could contribute to the higher number of ischemic lesions.