Hotspots of small strokes in glioma surgery: an overlooked risk?

Loit, Marie-Pierre; Rheault, François; Gayat, Étienne; Poisson, Isabelle; Froelich, Sébastien; Zhi, Nanxi; Velut, Stéphane; Mandonnet, Emmanuel

doi:10.1007/s00701-018-3717-3

Cited by 16 publications

(12 citation statements)

References 30 publications

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“…11,34 Interestingly, another recent study showed a slight decline in semantic fluency in patients with small infarcts following glioma surgery involving insulo-opercular areas. 27 However, as only 33 of our patients had a neurocognitive evaluation, we could not perform a subgroup analysis for surgeries in the dominant hemisphere, which may have revealed further cognitive sequelae.…”

Section: Clinical Functional and Cognitive Outcomesmentioning

confidence: 98%

Incidence and impact of stroke following surgery for low-grade gliomas

Berger¹,

Tzarfati²,

Costa³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIschemic complications are a common cause of neurological deficits following low-grade glioma (LGG) surgeries. In this study, the authors evaluated the incidence, risk factors, and long-term implications of intraoperative ischemic events.METHODSThe authors retrospectively evaluated patients who had undergone resection of an LGG between 2013 and 2017. Analysis included pre- and postoperative demographic, clinical, radiological, and anesthetic data, as well as intraoperative neurophysiology data, overall survival, and functional and neurocognitive outcomes.RESULTSAmong the 82 patients included in the study, postoperative diffusion-weighted imaging showed evidence of acute ischemic strokes in 19 patients (23%), 13 of whom (68%) developed new neurological deficits. Infarcts were more common in recurrent and insular surgeries (p < 0.05). Survival was similar between the patients with and without infarcts. Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced motor deficits (p = 0.024), decreasing to 16% (p = 0.082) and 37% (p = 0.024), respectively, at 1 year. Neurocognitive functions before and 3 months after surgery were generally stable for the two groups, with the exception of a decline in verbal rhyming ability among patients with infarcts. Confusion during awake craniotomy was a strong predictor of the occurrence of an ischemic stroke. Mean arterial pressure at the beginning of surgery was significantly lower in the infarct group.CONCLUSIONSRecurrent surgeries and insular tumor locations are risk factors for intraoperative strokes. Although they do not affect survival, these strokes negatively affect patient activity and performance status, mainly during the first 3 postoperative months, with gradual functional improvement over 1 year. Several intraoperative parameters may suggest the impending development of an infarct.

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Section: Clinical Functional and Cognitive Outcomesmentioning

confidence: 98%

Incidence and impact of stroke following surgery for low-grade gliomas

Berger¹,

Tzarfati²,

Costa³

et al. 2021

Journal of Neurosurgery

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“…In a series of patients with giant insular gliomas, ischaemic insults in eloquent brain regions were shown to be the leading factor associated with long-term neurological and neuropsychological morbidity ( 93 ). However, another study suggested the presence of small infarcts was only associated with a slight decrease in semantic fluency scores four months following surgery in patients with gliomas ( 115 ).…”

Section: Resultsmentioning

confidence: 99%

“…FactorEvidence/Key Points -deterioration in specific cognitive domains but no overall cognitive impairment at the group level (108) -a mixed picture: some patients experiencing cognitive improvement and others in the same study who experience cognitive decline or no change (39, 58, 60, 76, 110-113) -or improvements in some cognitive domains and deterioration (2) and/or no change(46) in others Overall, surgery influences cognition negatively initially followed by a recovery over several months in most cases.Surgical approachLimited specific evidence to indicate that this influences cognitive outcomes apart from use of awake craniotomies/intraoperative brain mapping having a positive (93, 118, 119) or negative (57) influence, although there is likely overlap with evidence for tumour location, which is a crucial influence on surgical approach undertaken.Extent of tumour resectionA number of studies indicate that higher extent of tumour resection does not negatively influence cognitive outcomes(3,4,36, 38, 47,49, 50, 52, 60), and some evidence it may positively influence cognitive outcomes(116).Complications during or following surgeryEvidence to suggest the development of infarcts are associated with worse cognitive outcomes following surgery(93,114,115).…”

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confidence: 99%

Influences on cognitive outcomes in adult patients with gliomas: A systematic review

et al. 2022

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People with brain tumors, including those previously treated, are commonly affected by a range of neurocognitive impairments involving executive function, memory, attention, and social/emotional functioning. Several factors are postulated to underlie this relationship, but evidence relating to many of these factors is conflicting and does not fully explain the variation in cognitive outcomes seen in the literature and in clinical practice. To address this, we performed a systematic literature review to identify and describe the range of factors that can influence cognitive outcomes in adult patients with gliomas. A literature search was performed of Ovid MEDLINE, PsychINFO, and PsycTESTS from commencement until September 2021. Of 9,998 articles identified through the search strategy, and an additional 39 articles identified through other sources, 142 were included in our review. The results confirmed that multiple factors influence cognitive outcomes in patients with gliomas. The effects of tumor characteristics (including location) and treatments administered are some of the most studied variables but the evidence for these is conflicting, which may be the result of methodological and study population differences. Tumor location and laterality overall appear to influence cognitive outcomes, and detection of such an effect is contingent upon administration of appropriate cognitive tests. Surgery appears to have an overall initial deleterious effect on cognition with a recovery in most cases over several months. A large body of evidence supports the adverse effects of radiotherapy on cognition, but the role of chemotherapy is less clear. To contrast, baseline cognitive status appears to be a consistent factor that influences cognitive outcomes, with worse baseline cognition at diagnosis/pre-treatment correlated with worse long-term outcomes. Similarly, much evidence indicates that anti-epileptic drugs have a negative effect on cognition and genetics also appear to have a role. Evidence regarding the effect of age on cognitive outcomes in glioma patients is conflicting, and there is insufficient evidence for gender and fatigue. Cognitive reserve, brain reserve, socioeconomic status, and several other variables discussed in this review, and their influence on cognition and recovery, have not been well-studied in the context of gliomas and are areas for focus in future research.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42017072976

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“…These functions often improve when analyzed up to 1 year after surgery 33 , 34 . With mild cognitive abnormalities having been related to small strokes in proximity to the resection cavity 35 , we now searched for any association between rim restriction and cognitive changes following surgery, yet our cohort was too small to detect significant differences between the groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical and prognostic implications of rim restriction following glioma surgery

Berger

Tzarfati

Serafimova

et al. 2022

Sci Rep

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Rim restriction surrounding the resection cavity of glioma is often seen on immediate post-op diffusion-weighted imaging (DWI). The etiology and clinical impact of rim restriction are unknown. We evaluated the incidence, risk factors and clinical consequences of this finding. We evaluated patients that underwent surgery for low-grade glioma (LGG) and glioblastoma (GBM) without stroke on post-operative imaging. Analyses encompassed pre- and postoperative clinical, radiological, intraoperative monitoring, survival, functional and neurocognitive outcomes. Between 2013 and 2017, 63 LGG and 209 GBM patients (272 in total) underwent surgical resection and were included in our cohort. Post-op rim restriction was demonstrated in 68 patients, 32% (n = 20) of LGG and 23% (n = 48) of GBM patients. Risk factors for restriction included temporal tumors in GBM (p = 0.025) and insular tumors in LGG (p = 0.09), including longer surgery duration in LGG (p = 0.008). After a 1-year follow-up, LGG patients operated on their dominant with post-op restriction had a higher rate of speech deficits (46 vs 9%, p = 0.004). Rim restriction on postoperative imaging is associated with longer duration of glioma surgery and potentially linked to brain retraction. It apparently has no direct clinical consequences, but is linked to higher rates of speech deficits in LGG dominant-side surgeries.

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Hotspots of small strokes in glioma surgery: an overlooked risk?

Cited by 16 publications

References 30 publications

Incidence and impact of stroke following surgery for low-grade gliomas

Incidence and impact of stroke following surgery for low-grade gliomas

Influences on cognitive outcomes in adult patients with gliomas: A systematic review

Clinical and prognostic implications of rim restriction following glioma surgery

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