Communicating hydrocephalus following surgery and adjuvant radiochemotherapy for glioblastoma

Montano, Nicola; D’Alessandris, Quintino Giorgio; Bianchi, Federico; Lauretti, Liverana; Doglietto, Francesco; Fernández, Eduardo B.; Maira, Giulio; Pallini, Roberto

doi:10.3171/2011.8.jns11738

Cited by 49 publications

(67 citation statements)

References 11 publications

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“…In one series of 12 such patients, 10 showed evidence of hydrocephalus (16). Interestingly, in a series of 7 patients with communicating hydrocephalus in the context of GBM, none showed MRI changes typical of LM (26). In this latter series CSF cytology was generally normal, although protein was typically elevated.…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal Metastases in High-Grade Adult Glioma: Development, Diagnosis, Management, and Outcomes in a Series of 34 Patients

et al. 2014

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Methods: Leptomeningeal metastases (LM) in the setting of glioma have often been thought to carry a particularly poor prognosis. We sought to better characterize this phenomenon through a review of patients with glioma seen in our institution over the preceding 10 years. We focus here on 34 cases with LM due to grade III or IV glioma. Over the period in question, we estimate a prevalence of almost 4% in those affected by grade IV tumors.Results: Leptomeningeal spread was present at the time of initial diagnosis in 4 patients. Among the others, LM occurred at the time of first progression of disease in 17. The median time to development of LM (excluding those where it was present at initial diagnosis) was 16.4 months [95% confidence interval (CI) 8.2–43.9]. The median time to further progression of disease following LM was 4.9 months (95% CI 3.1–6.9). Twenty-five patients were known to have died at the time of writing. Thus, median overall survival (OS) was 10.2 months (95% CI 8.8–14.7) following LM. At the time of diagnosis of LM, some form of treatment (chemotherapy and/or radiation vs. no treatment) increased OS (median 11.7 vs. 3.3 months, p < 0.001 by log-rank test). Use of radiation therapy (vs. no radiation) also increased OS, although the effect was more modest (7.8 vs. 16.8 months, p = 0.07). Higher Karnofsky Performance Status (KPS) at the time of diagnosis of LM was associated with OS (p = 0.007, median OS for KPS ≥90 19 months vs. 7.8 for KPS <90). In a two-variable model incorporating the use any treatment (vs. none) and KPS, the latter tended to be a more significant predictor of survival (p = 0.22 vs. p = 0.06 by likelihood-ratio test). This was also true for radiation (vs. none) and KPS (p = 0.27 vs. p = 0.02). No significant benefit could be demonstrated for the use of chemotherapy considered alone, either systemic or intrathecal. It should be noted that 4 of 9 patients receiving intrathecal chemotherapy had a ventriculo-peritoneal shunt in place during these injections, which may have reduced its effectiveness.Conclusion: Overall, treatment appears to improve outcomes. We favor maximal treatment, as tolerated, particularly with a KPS of ≥70. Such treatment would typically include radiation to the maximum tolerated dose, concurrent, and adjuvant chemotherapy (preferably with an alkyating agent), in addition to intrathecal treatment.

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Section: Discussionmentioning

confidence: 99%

Leptomeningeal Metastases in High-Grade Adult Glioma: Development, Diagnosis, Management, and Outcomes in a Series of 34 Patients

et al. 2014

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“…Ventricle opening (after radio-chemotherapy) is a significant predictor of communicating hydrocephalus in patients with high-grade gliomas. 8,10) On the other hand, any association between ventricle opening and leptomeningeal dissemination is controversial. 1,5) In our study, ventricle opening at the initial surgery or surgery for recurrent GBM did not predict hydrocephalus, although ventricle opening tended to be more frequent in the Hydro group than in the Non-hydro group.…”

Section: Discussionmentioning

confidence: 99%

“…In previous series, hydrocephalus or ventricle dilation developed in 3.4-26% of patients with primary high-grade gliomas or GBM. 8,10,13) In one study, all 10 patients underwent multiple craniotomies, and the frequency of hydrocephalus in patients with multiple craniotomies was 22%. 10) In our experience, communicating hydrocephalus usually developed after the diagnosis of recurrent GBM, but was very rarely associated with primary GBM or WHO grade II-III gliomas at the recurrent stage (detailed data are not shown).…”

Section: Discussionmentioning

confidence: 99%

“…3,4,7,9) Clinically, some patients suffer progressive ventricular dilation, mainly caused by communicating hydrocephalus, after the diagnosis of recurrent GBM. 6,8,10,13) We and others have speculated that undetectable tumor dissemination at the initial stage is the cause of the subsequent hydrocephalus. If so, magnetic resonance (MR) imaging should indicate a specific sign such as ventricular dilation at recurrence, even before the definitive diagnosis of subsequent hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Neuroimaging Findings in 12 Cases of Recurrent Glioblastoma With Communicating Hydrocephalus

Onuma

Ishikawa

Matsuda

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Clinically, recurrent glioblastoma multiforme (GBM) is often associated with communicating hydrocephalus. We hypothesized that there are specific magnetic resonance (MR) imaging findings at the diagnosis of recurrent GBM that predict subsequent hydrocephalus. Various clinical characteristics were investigated including outcome and MR imaging findings in 12 patients with recurrent GBM followed by hydrocephalus (Hydro group) and 21 patients with recurrent GBM without hydrocephalus (Non-hydro group). Patient age and presence of communicating hydrocephalus were significantly associated with poor outcome. Median survival with recurrent GBM was longer in the Non-hydro group than in the Hydro group. Low Karnofsky performance status (KPS) and poor recursive partitioning analysis (RPA) class (RPA class 3, 5, 6, or 7) at the diagnosis of recurrent GBM were associated with the presence of hydrocephalus. The incidence of leptomeningeal dissemination after recurrent GBM was higher in the Hydro group than in the Non-hydro group. Evans index and fractional anisotropy value showed no difference at the diagnosis of recurrent GBM, but some MR imaging findings indicated that lesion attached to the basal cistern and/or ventricle was closely associated with subsequent hydrocephalus. We recommend careful monitoring of the ventricle size and leptomeningeal dissemination, especially in patients with low KPS and/or poor RPA class, if MR imaging indicates that the lesion is attached to the basal cistern and/or ventricle at recurrence of GBM.

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“…10,11 Hemostasis remains an important intraoperative goal to reduce the onset of hematomas, whereas cerebrospinal fluid-related complications, such as hydrocephalus and pseudomeningocele, remain rare complications. 5,12 Focal neurologic deficits can largely be avoided through the use of intraoperative mapping and a reluctance to resect tumor from vital adjacent structures, such as vessels and nerves.…”

Section: Biopsy and Resectionmentioning

confidence: 99%

Multidisciplinary Care of Patients with Brain Tumors

Huang

Mueller

Rutkowski

et al. 2013

Surgical Oncology Clinics of North America

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Communicating hydrocephalus following surgery and adjuvant radiochemotherapy for glioblastoma

Abstract: Ventricular opening after radiochemotherapy and high CSF protein levels are significant predictors of communicating hydrocephalus in patients with GBM. The VP shunt surgery improves quality of life in these patients.

Cited by 49 publications

References 11 publications

Leptomeningeal Metastases in High-Grade Adult Glioma: Development, Diagnosis, Management, and Outcomes in a Series of 34 Patients

Leptomeningeal Metastases in High-Grade Adult Glioma: Development, Diagnosis, Management, and Outcomes in a Series of 34 Patients

Clinical Characteristics and Neuroimaging Findings in 12 Cases of Recurrent Glioblastoma With Communicating Hydrocephalus

Multidisciplinary Care of Patients with Brain Tumors

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