gms | German Medical Science

Objective: Cerebro Spinal Fluid (CSF) leakage is a feared complication associated with the implantation of Gliadel^® wafers. Pre-treatment with radiochemotherapy, reoperation and subsequent adjuvant treatment concepts might increase the risk of CSF leakage. Since implantation of Gliadel^® wafers is an efficient treatment option for recurrent Glioblastoma (GBM), the incidence of CSF leakages in a heavily pre-treated patient population is of interest.

Methods: We performed a search in our database for patients with recurrent primary GBM under/after radiochemotherapy (Stupp protocol), who were subject to re-resection, implantation of Gliadel^® wafers and intensified temozolomide one week on/ one week off (150 mg/m²/BS), initiated 4 weeks after surgical treatment. The occurrence of CSF leakage was evaluated according to clinical notes.

Results: We identified 23 patients who met the inclusion criteria. In all patients a watertight dural closure was intended and if not achieved a dura patch (bovine collagen) or galeal periosteal patch was implanted. Median observation time was 6 months (95% CI, [5,76-10,59]). We identified 4 patients with a subgaleal CSF leakage at 1 week (n=3) and 2 months (n=1). 2 patients were treated with a VP-Shunt (1 patient with leakage at 1 week and 2 months, respectively). In 2 patients the leak resolved spontaneously.

Conclusions: Even in this supposedly high-risk population, the incidence of CSF leakages requiring treatment is acceptably low. The assumed risk of CSF leakage should not per se prevent patients with recurrent GBM from treatment with Gliadel^® wafers.