Safe Brain Tumor Resection Does not Depend on Surgery Alone - Role of Hemodynamics

Bette, Stefanie; Wiestler, Benedikt; Mayinger, Felicitas; Kaesmacher, Johannes; Bretschneider, Martin; Barz, Melanie; Huber, Thomas S.; Ryang, Yu‐Mi; Kochs, Eberhard; Zimmer, Claus; Meyer, Bernhard; Boeckh‐Behrens, Tobias; Kirschke, Jan S.

doi:10.1038/s41598-017-05767-2

Cited by 21 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did not detect any additional peri-operative parameters to be associated with the occurrence of rim restriction, including previously reported ones, such as recurrent operations and decreased MAP or IOM abnormalities (Tables 1 and 2 ). 15 , 25 , 26 , 29 Findings of rim restriction have been associated with evidence of remnant blood products in the surgical cavity on postoperative imaging, yet no significant association were seen in our study 9 , 30 .…”

Section: Discussioncontrasting

confidence: 52%

Clinical and prognostic implications of rim restriction following glioma surgery

Berger

Tzarfati

Serafimova

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 52%

Clinical and prognostic implications of rim restriction following glioma surgery

Berger

Tzarfati

Serafimova

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…It is still not clear what measures can be taken to minimize the risk of infarctions in relation to tumor surgery. In a study exploring the relationship between perioperative hemodynamics, postoperative infarctions, and overall survival, diastolic blood pressure, a positive liquid balance, and duration of surgery were associated with postoperative infarction volumes [3]. Our data suggest a correlation between perioperative bleeding and infarction volume.…”

Section: Discussionmentioning

confidence: 52%

“…However, the relative importance of these factors is unknown. Several studies emphasize the importance of infarction volume [2][3][4], but even small ischemic lesions in eloquent locations may result in severe neurological sequelae [18]. Further, little is known about the risk of ischemic lesions in relation to surgical technique, e.g., use of suction vs. ultrasonic aspirator, subpial dissection vs. transsulcal approaches, outsidein vs. in-side-out resections, and more.…”

Section: Discussionmentioning

confidence: 99%

Brain infarctions after glioma surgery: prevalence, radiological characteristics and risk factors

et al. 2021

View full text Add to dashboard Cite

Background Prevalence, radiological characteristics, and risk factors for peritumoral infarctions after glioma surgery are not much studied. In this study, we assessed shape, volume, and prevalence of peritumoral infarctions and investigated possible associated factors. Methods In a prospective single-center cohort study, we included all adult patients operated for diffuse gliomas from January 2007 to December 2018. Postoperative infarctions were segmented using early postoperative MRI images, and volume, shape, and location of postoperative infarctions were assessed. Heatmaps of the distribution of tumors and infarctions were created. Results MRIs from 238 (44%) of 539 operations showed restricted diffusion in relation to the operation cavity, interpreted as postoperative infarctions. Of these, 86 (36%) were rim-shaped, 103 (43%) were sector-shaped, 40 (17%) were a combination of rim- and sector-shaped, and six (3%) were remote infarctions. Median infarction volume was 1.7 cm3 (IQR 0.7–4.3, range 0.1–67.1). Infarctions were more common if the tumor was in the temporal lobe, and the map shows more infarctions in the periventricular watershed areas. Sector-shaped infarctions were more often seen in patients with known cerebrovascular disease (47.6% vs. 25.5%, p = 0.024). There was a positive correlation between infarction volume and tumor volume (r = 0.267, p < 0.001) and infarction volume and perioperative bleeding (r = 0.176, p = 0.014). Moreover, there was a significant positive association between age and larger infarction volumes (r = 0.193, p = 0.003). Infarction rates and infarction volumes varied across individual surgeons, p = 0.037 (range 32–72%) and p = 0.026. Conclusions In the present study, peritumoral infarctions occurred in 44% after diffuse glioma operations. Infarctions were more common in patients operated for tumors in the temporal lobe but were not more common following recurrent surgeries. Sector-shaped infarctions were more common in patients with known cerebrovascular disease. Increasing age, larger tumors, and more perioperative bleeding were factors associated with infarction volumes. The risk of infarctions and infarction volumes may also be surgeon-dependent.

show abstract

“…21,38 It was suggested that strict control of blood pressure and fluid balance by the anesthesiologist may assist in decreasing the risk for stroke during surgery. 5 We found that low MAP at the beginning of surgery correlates with a higher rate of intraoperative strokes. Whether raising MAP by preoperative hydration can decrease the rate of stroke should be further studied.…”

Section: Intraoperative Indicators Of Strokementioning

confidence: 61%

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

Berger¹,

Tzarfati²,

Costa³

et al. 2021

Journal of Neurosurgery

View full text Add to dashboard Cite

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.

show abstract

Safe Brain Tumor Resection Does not Depend on Surgery Alone - Role of Hemodynamics

Cited by 21 publications

References 27 publications

Clinical and prognostic implications of rim restriction following glioma surgery

Clinical and prognostic implications of rim restriction following glioma surgery

Brain infarctions after glioma surgery: prevalence, radiological characteristics and risk factors

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

Contact Info

Product

Resources

About