Vol 47, No 2 (2013)

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Reoperations of patients with low-grade gliomas in eloquent or near eloquent brain areas

Wojciech Kaspera1, Krzysztof Majchrzak1, Barbara Bobek-Billewicz2, Anna Hebda2, Gabriela Stasik-Pres2, Henryk Majchrzak1, Piotr Ładziński1, Agnieszka Machowska-Majchrzak3
DOI: 10.5114/ninp.2013.34399
Neurol Neurochir Pol 2013;47(2):116-125.

Abstract

Background and purpose

Reoperations of patients with recurrent low-grade gliomas (LGG) are not always recommended due to a higher risk of neurological deficits when compared to initial surgery. The purpose of the present study was to evaluate surgical outcomes of patients operated on for recurrent LGG.

Material and methods

Sixteen patients who had surgery for recurrent LGG out of 68 LGG patients who underwent surgery at the Department of Neurosurgery in Sosnowiec, Poland between 2005 and 2011 were enrolled in the study.

Results

A large tumour volume prior to the initial surgery was the most significant parameter influencing LGG progression (96.6 cm3 vs. 47.9 cm3, p = 0.01). Increased incidence of epileptic seizures and decreased mental ability according to Karnofsky score were the most common symptoms associated with tumour recurrence. In the group of patients with malignant transformation, the relative cerebral blood volume (rCBV) was considerably increased (1.21 vs. 2.41, p < 0.01). No statistically significant difference was found in terms of the extent of resection between initial surgery and reoperation. Similarly, no significant difference was found in the number of patients with a permanent neurological deficit after initial surgery and reoperation.

Conclusions

Reoperations of the patients with recurrent LGG are not burdened with a higher risk of neurological sequelae when compared to initial surgery. The extent of resection during the surgery for LGG recurrence is comparable to initial surgery. The increase of rCBV seems to be a significant biomarker that indicates malignant transformation.

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Neurologia i Neurochirurgia Polska