Morbidity and mortality of craniotomy for excision of supratentorial gliomas

Abstract

Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (greater than 55 years) and those receiving high daily dose of preoperative dexamethasone (greater than or equal to 24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of Surgical Removal on Survival and Quality of Life in Patients With Supratentorial Glioblastoma

“…Whether gross-total tumor removal is efficacious in prolonging the survival of patients with glioblastoma remains unclear. [1][2][3][4][5]8,9,11,12,14,15) The variable results may be attributable to differences between the tumors and cohorts analyzed, or to differences in the methods used to determine the extent of tumor resection.…”

Motor Homunculus: Passive Mapping in Healthy Volunteers by Using Functional MR Imaging—Initial Results

“…One key to prolonged survival is cytoreductive excision of the brain tumor (23)(24)(25), generally used in conjunction with radiation and chemotherapy. Surgery alone can be associated with neurologic dysfunction in up to 25% of patients (26)(27)(28). Despite the poor prognosis of this condition, aggressive treatments can extend survival time and help to preserve the quality of life, provided that a surgically induced neurologic deficit can be avoided.…”

Management of malignant glioma: role of surgery in relation to multimodality therapy

“…In the series of Ciric et al (1987), 97% of patients with gross total or nearly gross total resection had improved or stable postoperative neurological status; in contrast, postoperative neurological worsening occurred in 40% of patients with partial resection. In two other series (Fadul et al, 1988;Vecht et al, 1990) no signi®cant difference was found in the incidence of neurological worsening following gross total resection compared with limited resection. These data from various studies suggest that radical tumor resection is associated with no greater or perhaps less risk of neurological compromise than with partial resection.…”

“…In the past decade, the 30-day operative mortality has ranged, in most series, from 0% to 3.5% (Fadul et al, 1988;Salcman, 1996); mortality in one series, however, was 17% (Hollerhage et al, 1991). In these same series, surgical morbidity, including increased neurological de®cit, ranged from 8 ± 16%.…”