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

Berger, Assaf; Tzarfati, Gali; Costa, Matias; Serafimova, Marga; Korn, Akiva; Vendrov, Irina; Alfasi, Tali; Krill, Dana; Aviram, Daniel; Moshe, Shlomit Ben; Kashanian, Alon; Ram, Zvi; Grossman, Rachel

doi:10.3171/2019.10.jns192301

Cited by 17 publications

(31 citation statements)

References 48 publications

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“…Sawaya et al [27] described neurological complications in 8.5%, Lonjaret et al [21] in 16% and Brell et al [4] in 20.5% of patients after surgery for brain tumours. In a study by Berger et al, immediate motor deficits were found in 22% and speech deficits in 3% of patients [3]. Our study shows that the deficits occurred directly after surgery in 78% of the patients who developed deficits, which is in line with previous studies [21].…”

Section: Neurological Deteriorationsupporting

confidence: 92%

“…Our numbers of postoperative ischemic lesions (14%) are lower than in the study by Gempt et al [15], who identified new postoperative ischemic lesions in 31% of newly diagnosed and in 80% of patients with recurrent gliomas. Other have described new ischemic lesions after glioma surgery in 23% [3], 64% [30] and 70% [34] of patients. Tumour location in proximity to perforating arteries [15], insular tumours [3] and recurrent gliomas [3,15] has been identified as a risk factor for postoperative ischemic lesions, and age was found to be an independent risk factor for stroke within 30 days after brain tumour surgery [2].…”

Section: Postoperative Ischemic Lesionsmentioning

confidence: 98%

“…Other have described new ischemic lesions after glioma surgery in 23% [3], 64% [30] and 70% [34] of patients. Tumour location in proximity to perforating arteries [15], insular tumours [3] and recurrent gliomas [3,15] has been identified as a risk factor for postoperative ischemic lesions, and age was found to be an independent risk factor for stroke within 30 days after brain tumour surgery [2]. Vascular reorganization or vessel obliteration by brain irradiation was suggested as an explanation for the increased number of ischemic lesions after resection of recurrent gliomas [15].…”

Section: Postoperative Ischemic Lesionsmentioning

confidence: 98%

“…The presumed eloquent areas were sensorimotor strip (precentral and postcentral gyri), dominant hemisphere perisilvian language areas (superior temporal, inferior frontal and inferior parietal areas), basal ganglia/internal capsule, thalamus and calcarine visual cortex The most common diagnosis was high-grade glioma, found in 69 patients (69 %) followed by low-grade glioma (WHO grade II) in 24 patients (24%). Median (IQR) preoperative tumour volume was 32.4 (11.2-74.5) cm 3 and resection grade was 96.5 (72-100) %.…”

Section: Tumour Locations Diagnosis and Tumour Volumesmentioning

confidence: 99%

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Time course of neurological deficits after surgery for primary brain tumours

et al. 2020

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Background The postoperative course after surgery for primary brain tumours can be difficult to predict. We examined the time course of postoperative neurological deficits and analysed possible predisposing factors. Method Hundred adults with a radiological suspicion of low- or high-grade glioma were prospectively included and the postoperative course analysed. Possible predictors of postoperative neurological deterioration were evaluated. Results New postoperative neurologic deficits occurred in 37% of the patients, and in 4%, there were worsening of a preoperative deficit. In 78%, the deficits occurred directly after surgery. The probable cause of deterioration was EEG-verified seizures in 7, ischemic lesion in 5 and both in 1, resection of eloquent tissue in 6, resection close to eloquent tissue including SMA in 11 and postoperative haematoma in 1 patient. Seizures were the main cause of delayed neurological deterioration. Two-thirds of patients with postoperative deterioration showed complete regression of the deficits, and in 6% of all patients, there was a slight disturbance of the function after 3 months. Remaining deficits were found in 6% and only in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of postoperative neurological deterioration and preoperative neurological deficits of remaining deficits. Conclusions Postoperative neurological deficits occurred in 41% and remained in 6% of patients. Remaining deficits were found in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of neurological deterioration and preoperative neurological deficits of remaining deficits.

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Section: Neurological Deteriorationsupporting

confidence: 92%

Section: Postoperative Ischemic Lesionsmentioning

confidence: 98%

Section: Postoperative Ischemic Lesionsmentioning

confidence: 98%

Section: Tumour Locations Diagnosis and Tumour Volumesmentioning

confidence: 99%

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Time course of neurological deficits after surgery for primary brain tumours

et al. 2020

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“…As to the insular glioma resection, most of the procedure was done among the main branches of M2, which may cause ischemia to the surrounding structure. Various mechanisms have been proposed for the development of intraoperative brain ischemia, including direct vascular damage, vasospasm, and kinking of arteries by the retraction of the brain [2,5]. Therefore, the identi cation and protection of blood vessels is particularly important for insular gliomas resection.…”

Section: Discussionmentioning

confidence: 99%

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

Hou

Huang

et al. 2021

Preprint

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Insular gliomas remain surgically challenge due to their complex anatomical position and microvascular supply. The incidence of ischemic complications is a risk that should not be ignored. The goal of this study was to analyze the incidence of ischemia and its risk factors, and also describe a single surgeon's arteries protection experience of insular gliomas resection. The authors studied 75 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Analysis included pre- and postoperative demographic, clinical, radiological including diffusion weighted imaging (DWI), as well as intraoperative neurophysiology data, and functional outcomes. Strategies such as “Residual Triangle”, “Basal Ganglia Reconstruction” and “Sculpting Technique” were used to protect lateral lenticulostriate arteries and main branches of M2 for maximal tumor resection according to the different classification of Berger-Sinai. Postoperative diffusion-weighted imaging showed acute ischemia in 44 patients, only 9 of whom developed new motor deficits. Flat inner edge (OR 0.144 95% CI 0.024, 0.876), and motor evoked potentials (MEPs) (<50%) (OR 18.182, 95% CI 3.311, 100.00) were determined to have significant associations with postoperative Critical Ischemia, which located in the posterior limb of the internal capsule or corona radiata. For insular gliomas resection, the protection of main branches of MCA is important. Insular gliomas resection might be with high incidence of ischemia uncovered by DWI which not always result in neurological deficits. Their own strategies maybe the feasible technical nuances allow the surgeon to achieve a thorough and safe resection. Motor evoked potentials is essential for its resection.

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Perioperative Acute Ischemic Stroke in Patients with Atrial Fibrillation

Shu

Jiang

Xiao

et al. 2023

Annals of Neurology

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Objective: Anticoagulation therapy is commonly interrupted in patients with atrial fibrillation (AF) for elective procedures. However, the risk factors of acute ischemic stroke (AIS) during the periprocedural period remain uncertain. We performed a nationwide analysis to evaluate AIS risk factors in patients with AF undergoing elective surgical procedures. Methods: Using the Nationwide Readmission Database, we included electively admitted adult patients with AF and procedural Diagnosis-Related Group codes from 2016 to 2019. Diagnoses were identified based on International Classification of Disease, 9th revision-Clinical Modification (ICD-10 CM) codes. We constructed a logistic regression model to identify risk factors and developed a new scoring system incorporating CHA 2 DS 2 VASc to estimate periprocedural AIS risk. Results: Of the 1,045,293 patients with AF admitted for an elective procedure, the mean age was 71.5 years, 39.2% were women, and 0.70% had a perioperative AIS during the index admission or within 30 days of discharge. Active cancer (adjusted OR [aOR] = 1.58, 95% confidence interval [CI] = 1.42-1.76), renal failure (aOR = 1.14, 95% CI = 1.04-1.24), neurological surgery (aOR = 4.51, 95% CI = 3.84-5.30), cardiovascular surgery (aOR = 2.74, 95% CI = 2.52-2.97), and higher CHA 2 DS 2 VASc scores (aOR 1.25 per point, 95% CI 1.22-1.29) were significant risk factors for periprocedural AIS. The new scoring system (area under the receiver operating characteristic curve [AUC] = 0.68, 95% CI = 0.67 to 0.79) incorporating surgical type and cancer outperformed CHA 2 DS 2 VASc (AUC = 0.60, 95% CI = 0.60 to 0.61). Interpretation: In patients with AF, periprocedural AIS risk increases with the CHA 2 DS 2 VASc score, active cancer, and cardiovascular or neurological surgeries. Studies are needed to devise better strategies to mitigate perioperative AIS risk in these patients.

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

Cited by 17 publications

References 48 publications

Time course of neurological deficits after surgery for primary brain tumours

Time course of neurological deficits after surgery for primary brain tumours

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

Perioperative Acute Ischemic Stroke in Patients with Atrial Fibrillation

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