Perioperative risk assessment of patients with gliomatosis cerebri

Abstract Background Gliomatosis-cerebri (GC) is a rare diffusely infiltrating malignant glial neoplasm. Presenting symptoms may include seizures, neurological deficits, and not infrequently, symptoms related to increased intra-cranial pressure(ICP). Surgical intervention, including brain biopsy may...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2017-02, Vol.98, p.334-338
Main Authors: Shimony, Nir, MD, Shofty, Ben, MD, Ram, Zvi, MD, Grossman, Rachel, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - mortality
Brain Neoplasms - surgery
Complications
Decompressive Craniectomy - mortality
Decompressive Craniectomy - trends
Female
Follow-Up Studies
Gliomatosis
Humans
ICP
Intracranial Hypertension - diagnostic imaging
Intracranial Hypertension - mortality
Intracranial Hypertension - surgery
Male
Middle Aged
Neoplasms, Neuroepithelial - diagnostic imaging
Neoplasms, Neuroepithelial - mortality
Neoplasms, Neuroepithelial - surgery
Neurosurgery
Perioperative Care - methods
Retrospective Studies
Risk Assessment - methods
Surgery
Survival Rate - trends
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Gliomatosis-cerebri (GC) is a rare diffusely infiltrating malignant glial neoplasm. Presenting symptoms may include seizures, neurological deficits, and not infrequently, symptoms related to increased intra-cranial pressure(ICP). Surgical intervention, including brain biopsy may induce worsening of these neurological symptoms. We reviewed our database to identify prognostic and risk factors for peri-operative deterioration specifically associated with elevated ICP. Methods Between 2006-2014 seventy-eight patients were treated for GC. Ten patients required peri-operative emergent treatment for elevated intracranial pressure (ICP). The clinical course and outcome of these 10 patients(study group) were characterized and compared to the remaining 68 patients. Results The study group patients developed life-threatening symptoms of increased ICP and required urgent decompressive-craniectomy (n=5 urgent DC after biopsy, n=2 urgent DC on admission) or aggressive medical therapy(n=3). Demographic and clinical variables were similar in both groups. In patients with severe symptoms of increased ICP, the enhancing tumor volume was significantly greater than in asymptomatic patients. In addition, radiological evidence of obliteration of the basal cisterns and herniation was more common in symptomatic patients. The proliferation index in the biopsied tumors was also significantly higher in patients with symptomatic ICP elevation. Conclusions Clinical symptoms and radiological appearance suggestive of elevated ICP at presentation, as well as volume of contrast enhancement and high Ki67 proliferation index may predict the need for aggressive rapid treatment to control ICP in a small, but significant subset of patients with GC. Further studies are needed to clarify the biological basis for the unusually clinical course in these tumors.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2016.11.014