Artikel
Implantation of carmustine wafers after resection of malignant glioma with and without opening of the ventricular system
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Autoren
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Abdelhalim Hussein
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Tammam Abboud
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Implantation of carmustine wafers in patients with malignant glioma is not recommended when the ventricular system is opened during tumor resection, because of the possible cytotoxic drug effect on the ventricular ependyma and the risk for subsequent obstructive hydrocephalus. The aim of this study was to evaluate the postoperative morbidity in patients with implanted carmustine wafers either with opened or not-opened ventricular system.
Methods: The analysis included 54 patients, all operated for malignant glioma in which carmustine wafers were placed into the resection cavity. In case of an opening of the ventricular system, the defect in the ventricle wall was closed using a collagen sponge coated with fibrinogen and thrombin prior to the implantation of the wafers. After surgery, all patients underwent an antibiotic prophylaxis, as well as an antiepileptic and steroid therapy for at least one week. Postoperative morbidity and Karnofsky performance score (KPS) were recorded at follow-up.
Results: The ventricular system was opened in 33 patients and remained intact in 21 patients. Both groups were comparable regarding age, rate of primary and recurrent glioma, preoperative KPS, achieved gross total resection, and number of implanted wafers. Mean follow-up time was 25 weeks. Nine patients (17%) had a postoperative brain edema with prolonged administration of steroids, 6 (11%) experienced new seizures, 5 (9%) had would infection and 1 (2%) had cerebral abscess. 9 of 33 patients (27%) with opened ventricular system and 4 of 21 patients (19%) with closed one had at least one postoperative morbidity. No significant difference in KPS at follow-up was found between the two groups (mean KPS of 63 and 67, respectively; p=0.175). Opening of the ventricular system was not associated with a significantly higher rate of postoperative morbidity (Fisher-Exact test, p=1.0). None of the patients developed an obstructive hydrocephalus.
Conclusion: Implantation of carmustine wafers after resection of malignant glioma after closing the opened ventricular system with collagen sponge coated with fibrinogen and thrombin was not associated with a significant increase in postoperative morbidity including obstructive hydrocephalus.
