Hydrocephalus after resection and adjuvant radiochemotherapy in patients with glioblastoma

Fischer, C.; Neidert, Marian C.; Péus, Dominik; Ulrich, Nils H.; Regli, Luca; Krayenbühl, Niklaus; Woernle, Christoph M.

doi:10.1016/j.clineuro.2014.02.012

Cited by 49 publications

(57 citation statements)

References 11 publications

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“…In most cases, hydrocephalus represents the consequence of surgical procedures which involve opening of the ventricular system of the brain (13)(14)(15)(16). In other study results, hydrocephalus appeared in 10% of the patients 10 years after the completion of radiation (15). A higher percentage of hydrocephalus in our study was mainly due to the higher number of surgical procedures performed on our patients.…”

Section: Discussionsupporting

confidence: 43%

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Chronic radiation-induced brain changes after irradiation of endocranium

Boban¹

2019

Medicinski podmladak

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Introduction:Irradiation is an essential part of therapy for brain malignant tumors that can prolong life for terminally ill patients. However, it causes radiation-induced complications, divided into acute, early delayed and late complications, that all vary on the applied radiation dose. Aim: The aim of this research was to determine the type and frequence of radiation-induced brain changes after irradiation of endocranium, and to determine correlations between the type of the changes, the irradiation dose and the time passed. Material and methods: This retrospective study included 41 patients of both sexes. The study was performed in the Center for Imaging Diagnostics of Oncology Institute of Vojvodina, using the BIRPIS database. Magnetic Resonance Imaging (MRI) scans consisted of: T2 axial, FLAIR axial, T1 pre-contrast axial, SWI, and T1 axial 3D MP-RAGE post-contrast tomograms. Evaluated changes were: cavernoma, angioma, gliosis, aneurysm, hemorrhage, hydrocephalus and other. Methods of descriptive statistics were used for the analysis. Results: The most common change in this study was gliosis (92.68%), followed by cavernoma (53.65%), hydrocephalus (26.83%) and angioma (21.95%). Hemorrhage and aneurysm were not found. Dilated perivascular spaces were found in 80% of the patients; this finding has not yet been described in this group of patients. Conclusion: Dilated perivascular spaces represent frequent post-irradiation sequelae in the white matter of the brain in treated patients, just after gliotic changes, that are the most frequent complication. Further studies are needed to explain the pathophysiologic mechanism of these changes.Medicinski podmladak / Medical Youth Mudrić M. Chronic radiation-induced brain changes after irradiation of endocranium. MedPodml 2019, 70(3):39-44 40 Uvod: Iradijacija predstavlja sastavni deo terapije kod maligniteta mozga i u velikoj meri unapređuje i produžava život obolelih. Postiradijacione komplikacije su česte, podeljene na akutne, rane odložene i kasne, i u velikoj meri zavise od primenjene doze zračenja. Cilj: Cilj ovog istraživanja je utvrđivanje tipa i učestalosti postiradijacionih promena moždanog parenhima nakon iradijacije endokranijuma, kao i utvrđivanje korelacije tipa lezija sa dozom iradijacije i proteklim vremenom od završetka iste. Materijal i metode: Ovom retrospektivnom studijom je obuhvaćen 41 ispitanik oba pola. Istraživanje je sprovedeno u Centru za imidžing dijagnostiku Instituta za onkologiju Vojvodine, sa korišćenjem podataka iz baze podataka BIRPIS. Magnetnorezonantno snimanje glave se sastojalo iz sledećih sekvenci: T2 aksijalnih, FLAIR aksijalnih, T1 prekontrastnih aksijalnih, SWI tomograma i T1 aksijalnih 3D MP-RAGE postkontrastnih tomograma. Posmatrane promene su: kavernom, angiom, glioza, aneurizma, hemoragija, hidrocefalus i drugo. Za obradu podataka su korišćene metode deskriptivne statistike. Rezultati: Najzastupljenija promena u ovoj studiji je glioza (92,68%), zatim kavernom (53,65%), hidrocefalus (26,83%) i angiom (21,95%). Hemoragija i an...

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Section: Discussionsupporting

confidence: 43%

“…Other studies showed the correlation between hydrocephalus and radiation-induced fibrosis, which disables resorption of cerebrospinal fluid (15). In most cases, hydrocephalus represents the consequence of surgical procedures which involve opening of the ventricular system of the brain (13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Chronic radiation-induced brain changes after irradiation of endocranium

Boban¹

2019

Medicinski podmladak

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“…First, we did not intentionally open the ventricle during the surgical procedure to check for fluorescence in the ventricular wall or to obtain ventricular wall samples. Because ventricular opening during surgical procedures can be a risk factor for postoperative hydrocephalus and leptomeningeal dissemination, which may potentially worsen the clinical condition and decrease survival (30)(31)(32)(33)(34)(35), opening of the ventricular system was performed only in cases where it was needed for radical supratotal resection of the tumor. Second, ventricular wall samples in the safe area were collected carefully to prevent postoperative neurological sequelae.…”

Section: Discussionmentioning

confidence: 99%

Histopathological implications of ventricle wall 5-aminolevulinic acid-induced fluorescence in the absence of tumor involvement on magnetic resonance images

et al. 2016

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During 5-aminolevulinic acid (ALA)-guided glioblastoma multiforme (GBM) surgery, we encountered fluorescence in ventricular walls that lacked enhancement on magnetic resonance (MR) images and were free of macroscopic invasion of tumor cells. However, the meaning of ventricular wall fluorescence during 5-ALA-guided surgery is still unknown. The aim of this study was to investigate the relationship between intraoperative 5-ALA fluorescence and histopathological findings of ventricular walls free of enhancement on MR images. Nineteen patients with newly diagnosed GBM located near the lateral ventricle underwent 5‑ALA fluorescence‑guided surgery. During the surgery, the ventricle wall was opened and investigated with the aid of a surgical microscope equipped with optical filters to examine 5‑ALA fluorescence of the ventricular wall. Twenty‑five ventricular wall tissues that were apparently free of tumor involvement by MR imaging and macroscopic observation were obtained during surgery. Among the 19 cases with brightly fluorescing tumor masses, 11 patients (57.9%) exhibited 5‑ALA‑induced fluorescence in the ventricular wall. Of the 25 ventricular wall samples, 11 exhibited 5‑ALA‑induced fluorescence; upon pathologic examination, tumors were present in 5 samples (45.5%), but the remaining 6 (54.5%) were free of tumor cells. A pathologic examination revealed no tumor cells in the 14 samples that lacked 5‑ALA‑induced fluorescence. Our data suggest the possibility that glioma cells exhibiting 5‑ALA fluorescence are present in the ventricle wall, despite no signs of tumor involvement in MR images. Further investigation of non‑tumor cells from tissues with 5‑ALA fluorescence is needed to understand the nature of this unexpected ventricular wall fluorescence.

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“…Fischer et al studied 151 patients and again noted a significant association between ventricular entry and the development of communicating hydrocephalus. 12 Of those patients studied, 73% with communicating hydrocephalus also had entry into the ventricles during resection, as opposed to 17% of those without hydrocephalus. Furthermore, leptomeningeal spread was more common in the communicating hydrocephalus group (27% vs 8%).…”

Section: Complications Of Ventricular Entrymentioning

confidence: 94%

Complications of ventricular entry during craniotomy for brain tumor resection

John¹,

Robin²,

Pabaney³

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Recent studies have demonstrated that periventricular tumor location is associated with poorer survival and that tumor location near the ventricle limits the extent of resection. This finding may relate to the perception that ventricular entry leads to further complications and thus surgeons may choose to perform less aggressive resection in these areas. However, there is little support for this view in the literature. This study seeks to determine whether ventricular entry is associated with more complications during craniotomy for brain tumor resection. METHODS A retrospective analysis of patients who underwent craniotomy for tumor resection at Henry Ford Hospital between January 2010 and November 2012 was conducted. A total of 183 cases were reviewed with attention to operative entry into the ventricular system, postoperative use of an external ventricular drain (EVD), subdural hematoma, hydrocephalus, and symptomatic intraventricular hemorrhage (IVH). RESULTS Patients in whom the ventricles were entered had significantly higher rates of any complication (46% vs 21%). Complications included development of subdural hygroma, subdural hematoma, intraventricular hemorrhage, subgaleal collection, wound infection, urinary tract infection/deep venous thrombosis, hydrocephalus, and ventriculoperitoneal (VP) shunt placement. Specifically, these patients had significantly higher rates of EVD placement (23% vs 1%, p < 0.001), hydrocephalus (6% vs 0%, p = 0.03), IVH (14% vs 0%, p < 0.001), infection (15% vs 5%, p = 0.04), and subgaleal collection (20% vs 4%, p < 0.001). It was also observed that VP shunt placement was only seen in cases of ventricular entry (11% vs 0%, p = 0.001) with 3 of 4 of these patients having a large ventricular entry (defined here as entry greater than a pinhole [< 3 mm] entry). Furthermore, in a subset of glioblastoma patients with and without ventricular entry, Kaplan-Meier estimates for survival demonstrated a median survival time of 329 days for ventricular entry compared with 522 days for patients with no ventricular entry (HR 1.13, 95% CI 0.65-1.96; p = 0.67). CONCLUSIONS There are more complications associated with ventricular entry during brain tumor resection than in nonviolated ventricular systems. Better strategies for management of periventricular tumor resection should be actively sought to improve resection and survival for these patients.

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Hydrocephalus after resection and adjuvant radiochemotherapy in patients with glioblastoma

Cited by 49 publications

References 11 publications

Chronic radiation-induced brain changes after irradiation of endocranium

Chronic radiation-induced brain changes after irradiation of endocranium

Histopathological implications of ventricle wall 5-aminolevulinic acid-induced fluorescence in the absence of tumor involvement on magnetic resonance images

Complications of ventricular entry during craniotomy for brain tumor resection

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