gms | German Medical Science

Objective: While the neurosurgical resection of cerebral glioma is focused on minimizing neurological morbidity and preserving quality of life in these patients having a limited prognosis, complications related to CSF circulation often necessitate revision surgery. The aim of this study was the development of a clinical algorithm for the treatment of this complication.

Method: We retrospectively identified patients with cerebral glioma undergoing additional surgery for hydrocephalus, tumor bed cyst, hygroma or a combination of these pathologies between 2007 and 2013. Number of previous tumor resections, operative details, adjuvant therapy, neuroradiological findings, clinical symptoms, type of revision surgery and outcome were recorded and descriptive statistical analysis was performed.

Results: 17 patients with glioblastoma (n=12) or anaplastic astrocytoma (n=5) were identified, whose treatment was complicated by hydrocephalus (n=4), tumor bed cyst (n=3) and hygroma (n=1) or a combination of hydrocephalus and either cyst or hygroma (n=9). Tumors were located in the frontal lobe (n=12) or parietal lobe (n=5). The mean number of previous tumor resections was n=2 (range 1-4) and ventricles were opened in 100% of cases. 95% of patients received radio-chemotherapy prior to complication and 86% had Gliadel wafers implanted. Patients with hydrocephalus or cysts mainly presented with headache and decreased levels of consciousness, whereas hygroma was associated with focal neurological impairment. Patients were treated with CSF shunts (n=12), hygroma drainage followed by shunting (n=2), endoscopic fenestration followed by shunting (n=2) and conservative treatment after negative lumbar tap (n=1). A mean of 3.4 operations were performed (range 1-10), regardless of single or combined pathology. 70% of patients experienced remission of the symptoms related to impaired CSF circulation.

Conclusions: Impaired CSF circulation occurred in patients, who underwent tumor resections for recurrent glioma and intensive adjuvant therapy. Ventricles were opened in 100% of cases. CSF shunts were implanted in 16 patients; in 4 patients shunting followed other surgical treatments. Repeated surgery was frequently required to achieve the surgical aim. However, the majority of patients improved. In a clinical algorithm, shunting appears to be an adequate treatment modality with good outcome, although higher revision rates than in non-neurooncological hydrocephalic patients should be expected.