Complications of glioma surgery

Abstract

Background. Nowadays extensive resection remains the best treatment for gliomas. However, postoperative complications can disturb the benefits of surgery. The risk of surgical complications must be assessed against the benefits of obtaining a total resection, especially for tumors of eloquent brain. Object. The goal of this study was to review present evidence of glioma resection concerning the frequency of complications,their causes, predictive risk factors and current methods of reducing the occurrence of these events. This review strives to consolidate information about complications and preventive measures as well as to establish the utility of tools to improve neurosurgical outcome. Methods. A review of the literature concerning the main postoperative complications in patients with glial tumors was done. We performed a search using key words "cerebral neoplasm", "cerebral tumor", "glioma" and "complications". Papers that namely discussed complications rates were included. Anatomic, physiologic, clinical features were taken into consideration in patients with postoperative complications as well as current methods of investigations. Results. Documented overall complication rates ranged from 10% to 35%, with overall mortality rates of 1.0%-15%. Studies of series undergoing surgery for malignant gliomas found at least one surgical complication in 3.4% of patients with a 4.5% risk in patients for hospital-associated complications such as surgical site infection. There was a wide range of types of complications. The presence of new or worsened neurological deficit was up to 20% as the highest reported rate for treatment of eloquent arias glioma. Relatively common complications were postoperative peritumoral edema (2%-10%), CSF fistula (1%-15%), wound infection (0%-4%), surgery-related hematoma (1%-5%) and early postoperative seizure (1%-12%). The risk for cardiac complications was 0.7%, for respiratory complications - 0.5%, for deep wound infection - 0.8%,for deep venous thromboses - 0.6%, for pulmonary embolus - 3.1%, for acute renal failure -1.3%. Infratentorial tumour location, reoperations and previous radiotherapy were factors related to the incidence of regional complications. Age over 60 and severe comorbidities were risk factors for systemic complications. Conclusion. Postoperative morbidity in glial tumor surgery may be reduced by: encouraging use of standardized protocols for regional and systemic complications, intraoperative navigation that allows surgeon to maximize resection while preserving neurological function, clinical vigilance and attention to details.