Time course of neurological deficits after surgery for primary brain tumours

Abstract

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.

Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and Meta-Analysis of 68 Observational Studies

“…Studies reporting frontotemporal tumor locations were associated with significantly increased pooled permanent postsurgical deficits. Similar findings have been reported with the use of standard neuronavigation (83). Conversely, insular location was negatively correlated with increased late postoperative deficits in meta-regression analyses.…”

“…preoperative fMRI mapping (n = 9), which is higher than reported numbers (6%-20%) (83,84). Our data showed a significant negative correlation between preoperative tumor volumes and the incidence of worsening postoperative deficits.…”

“…They evaluated a sample of 47 patients with tumors in the precentral gyrus, including both metastatic and primary lesions, resected with standard neuronavigation and cortical mapping. Likewise, other studies that used standard neuronavigation showed nonsignificant associations between preoperative tumor volume and late postoperative neurologic or cognitive deficits (3-6 months) (83,86). These results suggest more surgical effort with larger lesions (eg, fMRI and concomitant use of other advanced imaging techniques, intraoperative MRI, cortical stimulation) compared with smaller lesions, which ultimately may lead to a greater incidence of late postoperative deficits with lesions that were assumed to be more easily removed.…”

Quality of Life and Mortality after Craniotomy for Brain Tumor Removal: A South Korean Nationwide Cohort Study

“…[9,18] Yet other studies have reported that 5-6% of patients have long-term neurological sequelae after craniotomy for excision of brain tumor. [19,20] In our study, 15.8% of patients had newly acquired disability after craniotomy for excision of brain tumors, which was higher than that reported in other studies. [19,20] However, our study used a postoperative follow-up period of one year for all patients, resulting in more newly developed brain disabilities and postoperative sequelae being captured than in previous studies.…”

Sex-specific aspects of epidemiology, molecular genetics and outcome: primary brain tumours

“…No difference was observed between both sexes. 41 In another study on 1016 patients aged 65–89 years with a craniotomy for primary supratentorial malignant intraaxial tumours, risk factors for morbidity and mortality were not associated with sex, among the 816 admitted from home, around 34% had a change in living disposition which was associated with female sex among other factors. 42 In another cohort of 92 patients with gliomas and metastases involving the motor pathway, female sex, among other factors, was associated with a poorer functional prognosis and a poorer quality of life.…”