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The incidence and impact of post-operative stroke in surgery for low-grade glioma
EANS Academy. Grossman R. 09/26/19; 275980; EP03062
Dr. Rachel Grossman
Dr. Rachel Grossman

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Abstract
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Introduction: Postoperative neurological deficits may outweigh the benefit conferred by maximal resection of gliomas. Ischemic complications are a common cause of such deficits. We evaluated the incidence of intra-operative stroke in patients undergoing surgery for low-grade gliomas (LGG) and their long-term implications.
Methods: Between 2013-2017, 168 patients underwent resection or biopsy for LGG at our center. A full dataset was available in 82 patients that underwent resection. We retrospectively analyzed pre- and postoperative demographic, clinical, neuro-cognitive, radiological, anesthetic, and intraoperative neurophysiology data to characterize associated stroke.
Results: The immediate postoperative MRI showed evidence of stroke adjacent to the tumor resection cavity in 19 patients (23%), 13 of whom developed new neurological deficits. Infarcts were more common in patients with a recurrent tumor, especially those involving the Sylvian fissure (p< 0.05). Surgery for insular gliomas was strongly associated with postoperative infarcts (odds ratio =12.4, 95% confidence interval 2.21-69.8). There was no difference in survival between the groups, yet median Karnofsky Performance Status was lower for the infarct group compared to the non-infarct group at 3 months after surgery (p=0.016), with an improvement for the former over one year (p=0.04). Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced a new motor deficit (p=0.037), decreasing to 16% (p=0.028) and 37% (p=0.001), respectively, at one year. In general, neurocognitive analysis findings before and 3 months after surgery were unchanged, Confusion during awake craniotomy strongly predicted intra-operative stroke.
Conclusions: Intraoperative strokes are more prevalent among patients with recurrent surgeries, especially involving the insula. Strokes negatively affect the patients' performance status, especially during the first 3 postoperative months, with gradual functional improvement over one year. Certain intra-operative clinical and even behavioral indicators may suggest the impending development of an infarct.
Introduction: Postoperative neurological deficits may outweigh the benefit conferred by maximal resection of gliomas. Ischemic complications are a common cause of such deficits. We evaluated the incidence of intra-operative stroke in patients undergoing surgery for low-grade gliomas (LGG) and their long-term implications.
Methods: Between 2013-2017, 168 patients underwent resection or biopsy for LGG at our center. A full dataset was available in 82 patients that underwent resection. We retrospectively analyzed pre- and postoperative demographic, clinical, neuro-cognitive, radiological, anesthetic, and intraoperative neurophysiology data to characterize associated stroke.
Results: The immediate postoperative MRI showed evidence of stroke adjacent to the tumor resection cavity in 19 patients (23%), 13 of whom developed new neurological deficits. Infarcts were more common in patients with a recurrent tumor, especially those involving the Sylvian fissure (p< 0.05). Surgery for insular gliomas was strongly associated with postoperative infarcts (odds ratio =12.4, 95% confidence interval 2.21-69.8). There was no difference in survival between the groups, yet median Karnofsky Performance Status was lower for the infarct group compared to the non-infarct group at 3 months after surgery (p=0.016), with an improvement for the former over one year (p=0.04). Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced a new motor deficit (p=0.037), decreasing to 16% (p=0.028) and 37% (p=0.001), respectively, at one year. In general, neurocognitive analysis findings before and 3 months after surgery were unchanged, Confusion during awake craniotomy strongly predicted intra-operative stroke.
Conclusions: Intraoperative strokes are more prevalent among patients with recurrent surgeries, especially involving the insula. Strokes negatively affect the patients' performance status, especially during the first 3 postoperative months, with gradual functional improvement over one year. Certain intra-operative clinical and even behavioral indicators may suggest the impending development of an infarct.
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