Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

Abstract

Background There is a concern that glioma patients undergoing repeat craniotomies are more prone to complications. The study’s goal was to assess if the complication profiles for initial and repeat craniotomies were similar, to determine predictors of complications, and to compare results with those in the literature. Methods A retrospective study was conducted of glioma patients (WHO grade II–IV) who underwent either an initial or repeat craniotomy performed by the senior author from 2012 until 2019. Complications were recorded by discharge, 30 days, and 90 days postoperatively. New neurologic deficits were recorded by 90 days postoperatively. Multivariate regression was performed to identify factors associated with complications. A meta-analysis was performed to identify rates of complications based on number of prior craniotomies. Results Within the cohort of 714 patients, 400 (56%) had no prior craniotomies, 218 (30.5%) had undergone 1 prior craniotomy, and 96 (13.5%) had undergone ≥ 2 prior craniotomies. There were 27 surgical and 10 medical complications in 30 patients (4.2%) and 19 reoperations for complications in 19 patients (2.7%) with no deaths by 90 days. Complications, reoperation rates, and new neurologic deficits did not differ based on number of prior craniotomies. On multivariate analysis, older age (OR1.5, 95%CI 1.0–2.2) and significant leukocytosis due to steroid use (OR12.6, 95%CI 2.5–62.9) were predictors of complications. Complication rates in the cohort were lower than rates reported in the literature. Conclusion Contrary to prior reports in the literature, repeat craniotomies can be as safe as initial operations if surgeons implement best practices.

Haemostatic technique in malignant gliomas

“…Adequate haemostasis in cranial and spinal surgery is paramount. In patients operated upon for GBM, the literature reports a postoperative surgical haematoma in c.5% of them, with a high incidence in patients with diabetes mellitus [6]. After brain tumour removal, bleeding from the surgical wall cavity may occur and this is very difficult to control due to the frail and dysplastic neoplastic vessels infiltrating the surrounding brain parenchyma.…”

207 Intraoperative Functional Re-mapping Unveils Evolving Patterns of Cortical Plasticity

“…In addition, 3-dimensional pial-mesh reconstructions of the MRI obtained 3 months after Surg.1 were generated with BrainVISA/Anatomist software (Version 5.0, CEA I2BM, CATI Neuroimaging, Inserm IFR49, and CNRS, France) to allow a 3D visualization of individual cortical structures and a semi-automated MNI coordinate-surface matching of the model (Figure 1D). To demonstrate the reproducibility of the procedure used to position cortical sites despite a more challenging identification of gyro-sulcal anatomy at reoperation, 44 intra-and inter-observer correlation coefficients were computed. More specifically, the first observer positioned two times consecutively 100 stimulation sites randomly selected within the left hemisphere.…”

Repeated Awake Surgical Resection(s) for Recurrent Diffuse Low-Grade Gliomas: Why, When, and How to Reoperate?

“…From a functional perspective, repeated surgery does not increase the risk of complications in comparison to the primary operation, by considering traumatic (related to the surgical manipulation), cerebrospinal fluid–related (leaks, hydrocephalus), septic, hemorrhagic, ischemic, epileptic, and general (non-neurological) factors ( 33 , 40 ). In series specifically dedicated to DLGG, beyond the fact that no mortality was reported, all experiences supported the safety of multiple resections, with a low rate of permanent neurological impairment between 0% and 8.5%, similar to the morbidity rate of the first surgery ( 25 , 26 , 28 – 30 , 32 , 34 – 37 ).…”