Surgical and therapeutic strategy of recurrent malignant gliomas in intractable location

Abstract

Objective Recurrent malignant gliomas often violate important neurological function parts or deep brain structures due to tumor invasion, further increasing the difficulty of reoperation and treatment. Therefore, how to develop a reasonable treatment strategy, maximize the removal of the tumor, and ensure a basic quality of life of the patient, is nowadays hotly debated by scholars from various countries. This article aims to explore the reasonable treatment and optimal surgical strategy of recurrent malignant gliomas. Methods Four cases of recurrent malignant glioma were collceted. A comprehensive assessment on preoperative imaging, intraoperative operation, postoperative complications and long ⁃ term follow⁃up was made, and treatment strategy was elaborated. Results Postoperative MRI in 2 cases showed the recurrent tumors located in remnant edema parts, which were revealed by T2WI after first resections. One case underwent expanded resection of edema parts according to T2WI. This patient suffered short⁃term sensory aphasia and weakness of right limbs, but recovered by improving cerebral circulation, hyperbaric oxygen, auxiliary acupuncture and physical rehabilitation trainings. One case with brainstem glioma underwent precise resection by laser knife, without postoperative neurological disorders. All the 4 cases received postoperative chemotherapy with TMZ (200 mg/kg, 5 d/28 d). The average follow⁃up period was (14.00 ± 12.50) months. Conclusion For obvious recurrence of malignant glioma, reoperation is still the key factor to lengthen the survival of patients, and expanded resection of the edema area supplemented by T2WI can reduce recurrence. Under the precondition of maintaining the basic postoperative quality of life of patients (KPS > 70), expanded resection should be used. As for tumors adjacent to the eloquent areas, precise engraving resection should be used to minimize residual tumor cells． DOI：10.3969/j.issn.1672⁃6731.2012.06.010