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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...
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Published in: | World neurosurgery 2017-02, Vol.98, p.334-338 |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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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. |
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ISSN: | 1878-8750 1878-8769 |
DOI: | 10.1016/j.wneu.2016.11.014 |