Artikel
Early second-look surgery for residual glioma – procedure complications and volumetric analysis
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Autoren
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Amir Zolal
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Dresden
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Dresden
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: The extent of glioma resection has been shown to correlate with survival in high-grade and low-grade tumors. Apart from intraoperative imaging and fluorescence methods, second-look resection early after the tumor remnant is detected on postoperative MRI can be used to reach the goal of complete or maximal tumor resection. The objective of the study is to retrospectively evaluate the results of early second-look resections performed in our department between 2005 and 2012.
Method: 18 patients have been identified in our database that underwent two glioma resections within six weeks. Tumor enhancement was seen in all patients identified. Patients, in whom a two staged resection was planned before the first surgery were excluded from the analysis. Measurement of tumor volume was performed by segmentation on preoperative, first and second postoperative MRI scans using segmentation software. Surgical complications, neurological deteriorations and new ischemic lesions seen on DWI were evaluated.
Results: Of the 18 patients, 1 suffered from a major postoperative bleed after the second operation, which caused a profound neurological deterioration. This patient couldn’t be included in the volumetric analysis. Two other minor surgical complications were noted after the second surgery. A temporary neurological deterioration was observed in two patients after the first and in two patients after the second surgery. The results of histological examination differed in two cases between the first and second surgery. In the volumetric analysis, a total resection of the enhancing tumor part was reached in 4 of the 17 analyzed patients after the first surgery. After the second surgery, the resection was considered total in further 9 patients. Thus, total resection was reached after two surgeries in 13 of the 17 patients. The mean increase in tumor volume resection was 26%.
Conclusions: The present study suggests that early second-look surgery for the resection of a tumor remnant seen on postoperative MRI is a safe procedure, which leads to complete resection of the enhancing part of the glioma in a large proportion of selected patients. Further retrospective and prospective studies are needed to establish the impact on patient prognosis.
