gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Reactive cyst formation following the local therapy with Gliadel® in patients with malignant glioma and implications for the treatment

Reaktive Zysten mit einem deutlichen raumfordernden Effekt nach der Implantation von Gliadel Wafern: chirurgische Empfehlungen

Meeting Abstract

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  • corresponding author L. Dörner - Klinik für Neurochirurgie, UKSH Campus Kiel
  • H. M. Mehdorn - Klinik für Neurochirurgie, UKSH Campus Kiel
  • A. Nabavi - Klinik für Neurochirurgie, UKSH Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.06.03

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Dörner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Local chemotherapy is increasingly being used in the therapy of malignant gliomas. So far Gliadel ® is the only approved therapeutic. With an increasing use, distinctive side effects of this technique become evident. We report reactive cysts with a significant mass effect and give suggestions for the treatment.

Methods: In our series of 40 patients with malignant gliomas treated with Gliadel ® from 2004 to 2007 we had 5 cases of reactive cyst formation resulting in a clinical relevant mass effect. They occurred on an average 20 days after implantation (median 22, range 11–30).

To reduce intracranial pressure, we prescribed high dose corticosteroids and decompressed the cyst using different surgical techniques. In 3 patients we punctuated the cyst with a cannula through the craniotomy burr hole once or several times, in 3 patients we implanted Ommaya reservoirs for recurrent punctuation and in 3 cases macroscopically opened and decompressed the cyst. Eventually none of the patients died of the raised ICP. Up today two patients died due to the tumor disease. The mean survival time after Gliadel ® implantation is so far 12.4 months (range 6 to 36). In average the cysts were punctuated 2.4 times (median 2, range 1 to 3)

Results: Due to the small number of punctuation per cyst the least invasive approach, transcutaneously with a cannula, can be recommended, when the configuration of the burr hole or the craniotomy gap in relation to the cyst allows doing so. Otherwise or when additional reasons, e.g. a hygroma, appear an Ommaya reservoir implantation or open decompression is a choice.

Conclusions: Reactive cyst formation following Gliadel ® implantation in patients with recurrent malignant glioma is a noteworthy complication and should be cautiously monitored in the following 5 weeks.