Safe Brain Tumor Resection Does not Depend on Surgery Alone - Role of Hemodynamics

Stefanie Bette,Yu-Mi Ryang,Johannes Kaesmacher,Jens Gempt,Bernhard Meyer,Felicitas Wiedenmann,Jan S Kirschke,Thomas Huber,Eberhard Kochs,Claus Zimmer,Melanie Barz,Tobias Boeckh-Behrens,Martin Bretschneider,Benedikt Wiestler

doi:10.1038/s41598-017-05767-2

Stefanie Bette, Yu-Mi Ryang + Show 12 more

Open Access

https://doi.org/10.1038/s41598-017-05767-2

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Abstract

Aim of this study was to determine if perioperative hemodynamics have an impact on perioperative infarct volume and patients’ prognosis. 201 cases with surgery for a newly diagnosed or recurrent glioblastoma were retrospectively analyzed. Clinical data and perioperative hemodynamic parameters, blood tests and time of surgery were recorded. Postoperative infarct volume was quantitatively assessed by semiautomatic segmentation. Mean diastolic blood pressure (dBP) during surgery (rho −0.239, 95% CI −0.11 – −0.367, p = 0.017), liquid balance (rho 0.236, 95% CI 0.1–0.373, p = 0.017) and mean arterial pressure (MAP) during surgery (rho −0.206, 95% CI −0.07 – −0.34, p = 0.041) showed significant correlation to infarct volume. A rank regression model including also age and recurrent surgery as possible confounders revealed mean intraoperative dBP, liquid balance and length of surgery as independent factors for infarct volume. Univariate survival analysis showed mean intraoperative dBP and MAP as significant prognostic factors, length of surgery also remained as significant prognostic factor in a multivariate model. Perioperative close anesthesiologic monitoring of blood pressure and liquid balance is of high significance during brain tumor surgery and should be performed to prevent or minimize perioperative infarctions and to prolong survival.

Highlights

Aim of this study was to determine if perioperative hemodynamics have an impact on perioperative infarct volume and patients’ prognosis. 201 cases with surgery for a newly diagnosed or recurrent glioblastoma were retrospectively analyzed
The patient population comprised 179 patients with 201 cases (108 m/71 f; mean age at surgery 61.3y−/+ 12.5) with surgery for a glioblastoma (WHO grade IV); patient characteristics are summarized in Table 1. 135/179 patients presented with initial diagnosis of a glioblastoma, 44/179 patients had recurrent disease and previous surgery
Mean intraoperative diastolic blood pressure during glioblastoma surgery is independently associated with postoperative infarct volume and in univariate analysis with overall survival suggesting that close monitoring and prevention of low dBP is of high significance to prevent or minimize perioperative ischemia and to prolong survival

Summary

Introduction

Aim of this study was to determine if perioperative hemodynamics have an impact on perioperative infarct volume and patients’ prognosis. 201 cases with surgery for a newly diagnosed or recurrent glioblastoma were retrospectively analyzed. Perioperative close anesthesiologic monitoring of blood pressure and liquid balance is of high significance during brain tumor surgery and should be performed to prevent or minimize perioperative infarctions and to prolong survival. Other studies indicated that postoperative ischemia and postoperatively acquired deficits correlate with overall survival and that perioperative ischemia might introduce hypoxia-mediated tumor growth[5,6,7]. According to these studies, prevention of perioperative infarction is important for patients’ functional independence and prognosis. This study aimed to analyze hemodynamic parameters during and after brain tumor surgery and correlate them to postoperative infarct volume and overall survival

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