Complication rate after second craniotomy in patients with high grade gliomas.

Kocken, J.G.W. (Justus) (2013) Complication rate after second craniotomy in patients with high grade gliomas. thesis, Medicine.

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Abstract

Introduction: High grade gliomas (HGG – WHO grade 3 (anaplastic glioma) and WHO grade 4 (glioblastoma multiforme (GBM)) are the most common primary brain tumors in adults. The incidence is approximately 5/100.000 per year, and GBM is the second most common cause of cancer-related death in the young adult age group. Because of its invasive nature, complete resection of a High Grade Glioma (HGG) is difficult, and most recur or progress despite optimal surgical and adjuvant treatment. Most tumors recur locally and re-operation may increase effectiveness of adjuvant therapies. Arguments against re-operations are usually based on the limited duration and poor quality of survival. However, a few reports concerning re-operation complications have been published. The aim of this study was to investigate the complication rate after second surgery in patients with HGG. Patient and methods: 56 Adult patients, operated for a histologically confirmed HGG in the period 2002-2011 were included. All patients received the same initial treatment with surgical resection, and postoperative radio-chemotherapy. Post-operatively follow up of the patients were regular MRI and clinical controls in an attempt to detect tumor recurrence at an early stage. In case of recurrence, the patient was offered reoperation as a secondary therapy followed by adjuvant therapy if suitable. Results: The overall complication rate after re-operation in the study was 51.8%, affecting 29 patients. The most frequent complications were neurological deficits, and this affected 17 patients (30.4%). There was a clear difference between patient groups related to the use of neuro-navigation during surgery. In the group where neuro-navigation was used the neurological complication rate was 21.7%, compared to 36.4% in the non-neuro-navigation group. Discussion: The risk of complications is significant in second surgery for HGG, especially for new or worsening of neurological deficits. The risk of neurological complications seem to be lower when neuro-naviation is used, and suggests that complication rates may be further reduced if navigation is used on all patients. This can make a surgical approach to recurrent GBM’s a more secure option. Based on this it’s recommendable to use neuro-navigation when re-operation is chosen as secondary therapy. Surgical treatment should always be considered as a therapeutic option when treating recurrent GBM.

Item Type:	Thesis (Thesis)
Supervisor name:	Kuks, Jan B.M.
Supervisor name:	Helland, Christian A. MD and Mahesparan, Ruby MD and Department of Neurosurgery and Haukeland University Hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:47
Last Modified:	25 Jun 2020 10:47
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/802

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