Glioma surgery and postoperative complications

Glioma surgery and postoperative complications. Does glioma have to be operated on? What are the postoperative complications?There are many complications after glioma, so is surgery still necessary?What are the complications of glioma surgery? Due to the advancement of imaging technology, nerve anesthesia, and the application of intraoperative neuronavigation, nerve monitoring, MRI and other methods, the resection technology of gliomas continues to improve, but glioma surgery still has the problem of postoperative complications.

What are the complications of glioma surgery?

Because high-grade gliomas are highly aggressive, difficult to remove, and highly recurring, the treatment and prognosis of gliomas have always been a topic of great concern to glioma patients and their families. Even with comprehensive treatment such as surgical resection, radiotherapy, and chemotherapy, the prognosis of high-grade glioma is still poor, with a 2-year survival rate of only 26.5%.

Low-grade gliomas have a better prognosis, with a 5-year survival rate of 58-72%. However, in high-grade gliomas, there is more and more evidence that emphasizes the importance of tumor volume to patient survival and the role of large-scale resection in reducing the conversion rate of malignant tumors.

What are the complications of glioma surgery?

1. Hematoma

In the existing surgical cases, 1-4% of patients have neurological deficits due to postoperative hematoma. These patients usually have problems with the level of consciousness, neurological defects and postoperative seizures. Once the patient has intracranial hypertension And bleeding should be treated immediately to prevent permanent neurological deficits. Unintentionally leaving tumor residues during the operation or due to intratumoral bleeding and edema around the tumor after partial resection.

2. Local complications

Local complications refer to complications related to the surgical site (infection, pseudomeningocele) or brain (epilepsy, hydrocephalus, pneumocerebral), and do not cause neurological deficits. The incidence in patients undergoing glioma resection is 3% to 5% and is related to the patient’s age. Patients older than 61 years of age have more major regional complications than patients younger than 61 years of age.

3. Epilepsy

Seizures of epilepsy occur in about 1-7.5% of craniotomy operations. Patients who have a history of epilepsy before surgery and whose tumor is close to the motor cortex may have an increased risk of postoperative seizures. Epilepsy that occurs due to parenchymal stimulation during resection 24-48 hours after surgery may have a devastating effect on the recovery of nerve function.

4. Infection

The incidence of infectious complications after intracranial incision is about 1%-3%; this includes different types of infections such as wound infection (0.75–2.9%), meningitis (0.5–1%), and subdural Empyema (0.325%). Factors that contribute to the risk of postoperative infection include corticosteroid use, diabetes, proximity to the sinuses, nutritional status, and whether there is cerebrospinal fluid leakage or fistula.

5. Hydrocephalus

The incidence of postoperative hydrocephalus is 0.25-1.5%. Obstructive hydrocephalus may be caused by the location of the tumor. Tumors or lesions of the upper midbrain vermis may cause swelling after surgery and may cause greater harm to the patient .

 6. Cerebrospinal fluid leakage

The total incidence of postoperative cerebrospinal fluid leakage varies, and is generally related to the location of the tumor and the surgical method. The incidence of glioma after craniotomy is about 3-14%.

7. Systemic complications

The incidence of systemic complications is about 4-8%. Including congestive heart failure/volume overload, pneumonia, venous thrombosis (DVT)/pulmonary embolism (PE), cardiac ischemia, and postoperative atrial fibrillation and other arrhythmias. Among them, elderly patients have a higher risk of systemic complications.

There may be some special and serious complications after glioma surgery:

1. Nervous system complications

Nervous system complications are defined as direct neurological defects caused by the direct effects of surgery on the brain or its blood supply or indirectly caused by cerebral edema. On average, their incidence ranges from 3-8%. They are affected by factors such as the patient’s age and tumor location. They are a relatively special and serious complication.

2. Cerebrovascular system damage

Cerebrovascular system damage is a rare but extremely destructive complication. The probability of direct vascular injury is reported to be 1-2%. Vascular complications can be divided into arterial and venous injuries. Arterial damage can lead to insufficient blood supply to the arteries, usually immediately after surgery. Vein damage can cause local congestion and overall congestive edema. The most dangerous thing is deep veins, such as the internal cerebral vein, and the congestion of the middle cerebral vein can cause long-term disturbance of consciousness.

Glioma has the above postoperative complications, so is surgery still necessary?

Some patients were afraid of surgery because they were worried about complications after surgery. What needs to be clear is that various research data in recent years have shown that total surgical resection and most tumor resection can effectively improve the survival benefits of patients with glioma, and can slow down the time of tumor development. The mortality rate has changed since the 1990s. The reported rate was 3.3%, down to about 2.4% and the current 1.7%.

Surgery is still an excellent way to treat and prolong the survival of patients with malignant glioma. The craniotomy for glioma is becoming more and more sophisticated, trying to minimize the removal and reduce complications. This places extremely high demands on the pre-diagnosis and treatment and intraoperative tumor resection techniques.

(source:chinanet, reference only)

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