Journal of Neuro-Oncology

, Volume 107, Issue 3, pp 599–607

Risk of ischemia in glioma surgery: comparison of first and repeat procedures

  • Stephan Dützmann
  • Florian Geßler
  • Andrea Bink
  • Johanna Quick
  • Kea Franz
  • Volker Seifert
  • Christian Senft
Clinical Study

Abstract

The role of repeat resection in the multimodal treatment of gliomas is unclear. Repeat surgery theoretically carries a higher risk of inducing neurological deficits, which might even out any advantage of cytoreduction. We sought to determine whether the occurrence of perioperative infarction is higher for repeat surgery than for first surgery, and sought to identify factors associated with the occurrence of postoperative infarction. Therefore, we searched our database to identify patients who were operated for primary or recurrent glial tumors between October 2007 and October 2010. We analyzed 177 procedures, of which 130 (73.4%) were first surgeries and 47 (26.5%) were repeat. Initial WHO grades, KPS scores, and age were evenly distributed between the groups. Forty-six (26.0%) patients had new DWI lesions on their postoperative MRI scan. Eighteen (10.2%) patients had new lesions greater than 4 cm3. Among these were 11 (6.2%) patients, for whom the new lesion caused neurologic deficit. There was no difference between first and repeat surgery with regard to the occurrence of new DWI lesions (27.7 vs. 21.3%, P = 0.77) or neurological deficits (10.0 vs. 10.6%, P = 1.0). Tumor location in the insula, operculum, and temporal lobe was found to be significantly associated with the occurrence of new DWI lesions. We conclude that repeat surgery should not be withheld as a treatment option for patients with recurrent gliomas for fear of a higher risk of postoperative infarction or new neurologic deficit than the first surgery.

Keywords

Glioma Infarction Repeat surgery DWI lesion Retrospective analysis 

References

  1. 1.
    Schafer N, Tichy J, Thanendrarajan S, Kim Y, Stuplich M, Mack F, Rieger J, Simon M, Scheffler B, Bostrom J, Steinbach JP, Herrlinger U, Glas M (2011) Ifosfamide, carboplatin and etoposide in recurrent malignant glioma. Oncology 80(5–6):330–332PubMedCrossRefGoogle Scholar
  2. 2.
    Gilbert MR, Kuhn J, Lamborn KR, Lieberman F, Wen PY, Mehta M, Cloughesy T, Lassman AB, Deangelis LM, Chang S, Prados M (2011) Cilengitide in patients with recurrent glioblastoma: the results of NABTC 03-02, a phase II trial with measures of treatment delivery. J Neurooncol (Epub ahead of print)Google Scholar
  3. 3.
    Nieder C, Astner ST, Mehta MP, Grosu AL, Molls M (2008) Improvement, clinical course, and quality of life after palliative radiotherapy for recurrent glioblastoma. Am J Clin Oncol 31(3):300–305PubMedCrossRefGoogle Scholar
  4. 4.
    Mandl ES, Dirven CM, Buis, Postma TJ, Vandertop WP (2008) Repeated surgery for glioblastoma multiforme: only in combination with other salvage therapy. Surg Neurol 69(5):506–509. doi:10.1016/j.surneu.2007.03.043 discussion 509PubMedCrossRefGoogle Scholar
  5. 5.
    Easaw JC, Mason WP, Perry J, Laperriere N, Eisenstat DD, Del Maestro R, Belanger K, Fulton D, Macdonald D (2010) Canadian recommendations for the treatment of recurrent or progressive glioblastoma multiforme. Curr Oncol (Toronto, Ont) 18(3):e126–e136Google Scholar
  6. 6.
    Barbagallo GM, Jenkinson MD, Brodbelt AR (2008) ‘Recurrent’ glioblastoma multiforme, when should we reoperate? Br J Neurosurg 22(3):452–455. doi:10.1080/02688690802182256 PubMedCrossRefGoogle Scholar
  7. 7.
    Terasaki M, Ogo E, Fukushima S, Sakata K, Miyagi N, Abe T, Shigemori M (2007) Impact of combination therapy with repeat surgery and temozolomide for recurrent or progressive glioblastoma multiforme: a prospective trial. Surg Neurol 68(3):250–254PubMedCrossRefGoogle Scholar
  8. 8.
    Tofilon PJ, Fike JR (2000) The radioresponse of the central nervous system: a dynamic process. Radiat Res 153(4):357–370PubMedCrossRefGoogle Scholar
  9. 9.
    Hwang SY, Jung JS, Kim TH, Lim SJ, Oh ES, Kim JY, Ji KA, Joe EH, Cho KH, Han IO (2006) Ionizing radiation induces astrocyte gliosis through microglia activation. Neurobiol Dis 21(3):457–467PubMedCrossRefGoogle Scholar
  10. 10.
    Bernstein M, Gutin PH (1981) Interstitial irradiation of brain tumors: a review. Neurosurgery 9(6):741–750PubMedCrossRefGoogle Scholar
  11. 11.
    Quant EC, Drappatz J, Wen PY, Norden AD (2010) Recurrent high-grade glioma. Curr Treat Options Neurol 12(4):321–333PubMedCrossRefGoogle Scholar
  12. 12.
    Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98(6):1175–1181. doi:10.3171/jns.2003.98.6.1175 PubMedCrossRefGoogle Scholar
  13. 13.
    Xu JF, Fang J, Shen Y, Zhang JM, Liu WG, Shen H (2011) Should we reoperate for recurrent high-grade astrocytoma? J Neurooncol 105(2):291–299PubMedCrossRefGoogle Scholar
  14. 14.
    Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D (2005) Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 23(34):8863–8869PubMedCrossRefGoogle Scholar
  15. 15.
    Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW, Gutin PH, Larson DA (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36(2):433–441PubMedCrossRefGoogle Scholar
  16. 16.
    Veninga T, Langendijk HA, Slotman BJ, Rutten EH, van der Kogel AJ, Prick MJ, Keyser A, van der Maazen RW (2001) Reirradiation of primary brain tumours: survival, clinical response and prognostic factors. Radiother Oncol 59(2):127–137PubMedCrossRefGoogle Scholar
  17. 17.
    Brandes AA, Franceschi E, Tosoni A, Bartolini S, Bacci A, Agati R, Ghimenton C, Turazzi S, Talacchi A, Skrap M, Marucci G, Volpin L, Morandi L, Pizzolitto S, Gardiman M, Andreoli A, Calbucci F, Ermani M (2010) O(6)-methylguanine DNAmethyltransferase methylation status can change between first surgery for newly diagnosed glioblastoma and second surgery for recurrence: clinical implications. Neurooncology 12(3):283–288Google Scholar
  18. 18.
    Felsberg J, Thon N, Eigenbrod S, Hentschel B, Sabel MC, Westphal M, Schackert G, Kreth FW, Pietsch T, Loffler M, Weller M, Reifenberger G, Tonn JC (2011) Promoter methylation and expression of MGMT and the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2 in paired primary and recurrent glioblastomas. Int J Cancer 129(3):659–670PubMedCrossRefGoogle Scholar
  19. 19.
    Helseth R, Helseth E, Johannesen TB, Langberg CW, Lote K, Ronning P, Scheie D, Vik A, Meling TR (2010) Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme. Acta Neurol Scand 122(3):159–167PubMedCrossRefGoogle Scholar
  20. 20.
    Clarke Dagger JL, Ennis Dagger MM, Yung WK, Chang SM, Wen PY, Cloughesy TF, Deangelis LM, Robins HI, Lieberman FS, Fine HA, Abrey L, Gilbert MR, Mehta M, Kuhn JG, Aldape KD, Lamborn KR, Prados MD (2011) Is surgery at progression a prognostic marker for improved 6-month progression-free survival or overall survival for patients with recurrent glioblastoma? Neurooncology 13(10):1118–1124Google Scholar
  21. 21.
    Park JK, Hodges T, Arko L, Shen M, Dello Iacono D, McNabb A, Olsen Bailey N, Kreisl TN, Iwamoto FM, Sul J, Auh S, Park GE, Fine HA, Black PM (2010) Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28(24):3838–3843PubMedCrossRefGoogle Scholar
  22. 22.
    Ulmer S, Braga TA, Barker FG 2nd, Lev MH, Gonzalez RG, Henson JW (2006) Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology 67(9):1668–1670PubMedCrossRefGoogle Scholar
  23. 23.
    Smith JS, Lin H, Mayo MC, Bannerjee A, Gupta N, Perry V, Cha S (2006) Diffusion-weighted MR imaging abnormalities in pediatric patients with surgically treated intracranial mass lesions. J Neurooncol 79(2):203–209PubMedCrossRefGoogle Scholar
  24. 24.
    Smith JS, Cha S, Mayo MC, McDermott MW, Parsa AT, Chang SM, Dillon WP, Berger MS (2005) Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury. J Neurosurg 103(3):428–438PubMedCrossRefGoogle Scholar
  25. 25.
    Barker FG 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, Wilson CB (1998) Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42(4):709–720 discussion 720–703PubMedCrossRefGoogle Scholar
  26. 26.
    Nimsky C, Ganslandt O, Tomandl B, Buchfelder M, Fahlbusch R (2002) Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience. Eur Radiol 12(11):2690–2703PubMedGoogle Scholar
  27. 27.
    Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055 discussion 1055–1046PubMedCrossRefGoogle Scholar
  28. 28.
    Vives KP, Piepmeier JM (1999) Complications and expected outcome of glioma surgery. J Neurooncol 42(3):289–302PubMedCrossRefGoogle Scholar
  29. 29.
    Khan RB, Gutin PH, Rai SN, Zhang L, Krol G, DeAngelis LM (2006) Use of diffusion weighted magnetic resonance imaging in predicting early postoperative outcome of new neurological deficits after brain tumor resection. Neurosurgery 59(1):60–66 discussion 60–66PubMedCrossRefGoogle Scholar
  30. 30.
    Kumabe T, Higano S, Takahashi S, Tominaga T (2007) Ischemic complications associated with resection of opercular glioma. J Neurosurg 106(2):263–269PubMedCrossRefGoogle Scholar
  31. 31.
    Sanai N, Polley MY, Berger MS (2010) Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112(1):1–9PubMedCrossRefGoogle Scholar
  32. 32.
    Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J (2009) Insular gliomas: the case for surgical management. J Neurosurg 110(4):685–695PubMedCrossRefGoogle Scholar
  33. 33.
    Smith GC, Pell JP (2003) Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ (Clinical research ed) 327(7429):1459–1461CrossRefGoogle Scholar
  34. 34.
    Lutsep HL, Albers GW, DeCrespigny A, Kamat GN, Marks MP, Moseley ME (1997) Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke. Ann Neurol 41(5):574–580PubMedCrossRefGoogle Scholar
  35. 35.
    Nonaka H, Akima M, Hatori T, Nagayama T, Zhang Z, Ihara F (2003) The microvasculature of the cerebral white matter: arteries of the subcortical white matter. J Neuropathol Exp Neurol 62(2):154–161PubMedGoogle Scholar
  36. 36.
    Sanai N, Berger MS (2010) Intraoperative stimulation techniques for functional pathway preservation and glioma resection. Neurosurg Focus 28(2):E1PubMedCrossRefGoogle Scholar
  37. 37.
    Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D (2002) The impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases. J Neurosurg 96(2):255–262PubMedGoogle Scholar
  38. 38.
    Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V (2011) Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12(11):997–1003PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Stephan Dützmann
    • 1
  • Florian Geßler
    • 1
  • Andrea Bink
    • 2
  • Johanna Quick
    • 1
  • Kea Franz
    • 1
  • Volker Seifert
    • 1
  • Christian Senft
    • 1
  1. 1.Department of NeurosurgeryJohann Wolfgang Goethe-UniversityFrankfurt/MainGermany
  2. 2.Department of NeuroradiologyJohann Wolfgang Goethe-UniversityFrankfurt/MainGermany

Personalised recommendations