gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

The prognostic role of ventricular opening during glioblastoma surgery – a retrospective single center cohort analysis

Meeting Abstract

  • Felix Behling - Abteilung für Neurochirurgie, Universitätsklinik Tübingen, Germany
  • Susan Noell - Abteilung für Neurochirurgie, Universitätsklinik Tübingen, Germany
  • Jens Schittenhelm - Abteilung für Neuropathologie, Universitätsklinik Tübingen, Germany
  • Ghazaleh Tabatabai - Abteilung für Neurochirurgie, Universitätsklinik Tübingen, Germany; Interdisziplinäres Zentrum für Neuroonkoloie, Universitätsklinik Tübingen, Germany; Hertie Institut für klinische Hirnforschung, Universitätsklinik Tübingen, Germany
  • Marcos Tatagiba - Abteilung für Neurochirurgie, Universitätsklinik Tübingen, Germany
  • Marco Skardelly - Abteilung für Neurochirurgie, Universitätsklinik Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.01.09

doi: 10.3205/16dgnc090, urn:nbn:de:0183-16dgnc0901

Published: June 8, 2016

© 2016 Behling et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Extent of tumor resection is one of the strongest prognostic factors of overall survival in glioblastoma patients. Opening the ventricle wall during resection is an obstacle that some surgeons are reluctant to surpass. Avoidance of opening the ventricular system is based on two concerns: the development of a communicating hydrocephalus and ependymal tumor spread. Thus we assessed the prognostic impact of ventricular opening on the development of hydrocephalus and on overall survival by multivariate analyses in primary glioblastomas.

Method: In this retrospective single center cohort analysis, glioblastoma patients, who were first operated from 2004 to 2013, were included in the study. Information on the established prognostic factors age, Karnofsky performance scale (KPS), extent of resection, MGMT promotor methylation status, postoperative treatment and preoperative tumor volume were included into the multivariate analysis.

Results: Out of 229 eligible cases, 15 patients received a ventriculo-peritoneal shunt due to hydrocephalus (7 %). Univariate regression suggested a higher chance to develop hydrocephalus in patients, in whom a ventricle was opened during resection. This was not confirmed by multivariate logistic regression including EOR and preoperative tumor volume (n=181). Median OS was 18.6 months (95% CI 15.9-20.6) in patients, in whom no ventricle was opened and 14.3 months (95% CI 12.9-16), in whom a ventricle was opened. Multivariate Cox regression (n=148) including the established predictors of OS (MGMT status, EOR, age, KPS and adjuvant treatment) suggested ventricular opening as an independent negative predictor of OS (RR 1.64, p=0.0067). However, additional inclusion of preoperative tumor volume into the multivariate analysis (n=117) did not confirm opening of the ventricle as an independent risk factor (RR 1.1, p=0.57) but the preoperative tumor volume itself (RR 1.9, p=0.005). Additionally age above 50 years (RR 2.7, p=0.0002), subtotal resection (RR 2.1, p=0.0017), unmethylated MGMT (2.8, p<0.0001), monotherapy (chemotherapy: RR 3.5, 0.012; radiotherapy: RR 2.3, 0.0002) and KPS_<70 (RR 2.0, p=0.022) were all independent negative prognostic factors of OS.

Conclusions: Our study suggests that ventricular opening during glioblastoma resection has no independent prognostic impact on OS or the development of hydrocephalus. It is rather the preoperative tumor volume that is associated with a higher rate of ventricular opening during resection and a shorter OS.