Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project

Abstract

Perioperative complications occur slightly more often following a second craniotomy for malignant glioma than after the first craniotomy. This should be considered when evaluating toxicities from intraoperative local therapies requiring craniotomy. Nevertheless, most patients are neurologically stable or improved after either their first or second craniotomy. This data set may serve as a benchmark for neurosurgeons and others in a discussion of operative risks in patients with malignant gliomas.

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

“…Although in our recent study we identified significant differences between recurrent and newly diagnosed glioma patients with respect to neurological outcome and incidence of postoperative ischemic lesions, there are still few and contradictory data available on the resection of recurrent intrinsic brain tumors. 1,2,4,8,15,19,28,29 Ultimately, even though we were able to detect relevant ischemic events by intraoperative monitoring, the key question remains of how to avoid these events. Certainly a meticulous surgical technique tailored to the vascular architecture at risk, whether cortical arteries and draining veins or subcortical perforating arteries, is the mainstay of a safe resection.…”

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

“…2,3 Few studies have explored the association between age and short-term postoperative outcomes, and the reports have been conflicting. [19][20][21][22] By using samples from patients who underwent resection of both primary and metastatic tumors, 2 studies associated age with an increased risk of major complications. 7,9 Two other studies, which included only patients who had bone metastases, reported an association between age and increased morbidity and mortality.…”

“…19,22 In contrast, 2 studies in patients with malignant glioma concluded that advanced age was not associated with increased morbidity, and no association was observed between age and postsurgical neurologic function. 20,21 Major limitations of previous study designs included limited assessment of preoperative and intraoperative factors, single-institution patient samples, 7,9,21,22 small sample sizes with few events, 7,21,22 and reliance on univariate analyses to arrive at the conclusions. 7,13,21,22 We identified a greater prevalence for prolonged LOS among elderly patients across our entire sample; however, there was no significant difference between age groups when we examined total hospital LOS as a continuous variable (Table 2).…”

“…Fifth, because there are suboptimal data on preoperative and postoperative neurologic function, these results cannot be compared against studies that only assessed neurologic function as a postoperative complication. 20,21 Finally, the surgical population captured by NSQIP may not be wholly representative of the US neurosurgical population, because selfselected institutions contribute patient data. However, the sex and race distributions in the NSQIP database are representative of the US population, and data are collected prospectively from a substantial number of various types of institutions, thus providing a large and diverse sample size.…”

“…Although a few studies have assessed the role of age on the short-term outcome of patients with a primary or metastatic tumors, these had numerous limitations. 7,9,[19][20][21][22] Because patients aged 75 years (and, in some cases, aged 65 years or !70 years) usually or frequently are excluded from most clinical trials, [13][14][15] there is a paucity of data regarding the risk of definitive surgical resection and its correlation with short-term, perioperative outcomes in these patients. Contrary to common assumptions, our analysis of a large, prospective, multi-institutional database suggests that advanced age does not predispose individuals undergoing aggressive surgical therapy for primary or metastatic intracranial tumor to increased risk for operative or short-term postoperative morbidity or mortality.…”