gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Risk of ischemia in glioma surgery – a comparison between first and repeat procedures

Meeting Abstract

  • S. Dützmann - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • F. Geßler - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • A. Bink - Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • J. Quick - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • K. Franz - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • C. Senft - Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.09.12

DOI: 10.3205/12dgnc090, URN: urn:nbn:de:0183-12dgnc0901

Published: June 4, 2012

© 2012 Dützmann et al.
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Outline

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Objective: The role of repeat resection in the multimodal treatment of gliomas is unclear. Repeat surgery theoretically carries a higher risk of inducing neurological deficits, which might even out any advantage of cytoreduction. We sought to determine if the rate of perioperative infarction is higher in repeat surgery than in first surgery. We further determined factors associated with the occurrence of postoperative infarction.

Methods: We retrospectively analyzed our prospectively collected glioma patient database and selected patients who were operated for primary or recurrent glial tumors between October 2007 and Oct 2010. Routinely, early postoperative MRI examinations at 1.5 or 3.0 T were performed within 72h. The medical records of 200 consecutive patients were reviewed and clinical and associated operative data were collected.

Results: We could analyze 177 procedures, of which 130 (73.4%) were first and 47 (26.5%) were repeat surgeries. Initial WHO grades, KPS scores and age were evenly distributed between groups. 46 (26.0%) patients had new DWI lesions on their postoperative MRI scan. 18 (10.2%) patients had new lesions greater than 4 cm. Among these were 11 (6.2%) patients, in whom the new lesion caused neurologic deficit. There was no difference between first and repeat surgeries regarding occurrence of new DWI lesions (27.7 vs. 21.3%, P = 0.77) as well as neurological deficits (10.0 vs. 10.6%, P = 1.0). Tumor location in the insula, operculum and temporal lobe was found to be significantly associated with occurrence of new DWI lesions.

Conclusions: Repeat surgery for gliomas does not carry a higher risk for the development of new postoperative DWI lesions than first resections, if meticulous microsurgical techniques are applied. Thus, weighing risk and benefits, repeated surgery should not be withheld as a treatment option for patient with recurrent gliomas for fear of a higher risk of postoperative infarction or new neurologic deficit than the primary surgery. The main risk factor for new postoperative DWI lesions is tumor location in the insular, opercular and temporal region.