K. Čustović (1) M. Omerhodzic (1) K. Dizdarevic (1) N. Iblizovic (1) A. Hasanagic (1) Z. Merhemic (2)
of Neurosurgery, KCUS
This paper was presented on 3rd Congress of the Croatian Neurolosurgical Society with international participation, Zagreb, Croatia, 6.-8. june 2002
Ovaj rad je usmeno prezentiran na 3. Kongresu hrvatskoga Neurohirurškog društva sa međunarodnim učećem, održanom u Zagrebu, R Hrvatska, od 6. do 8. juna 2002. godine
76 with recurrent
intracranial astrocytoma grade 3 and 4 were reoperated in our clinic
during the years 1996 - 2000. The median age of the patients was 41
years. 72% patients had astrocytoma grade 3 and 28% had astrocytoma
grade 4. In 58 out of 76 cases surgically resection was grossly total,
in others was subtotaly. Preoperative neurological status was the most
significant determinant of survival after reoperation in patients with
astrocytoma gradus 3. However, in patients with astrocytoma gradus 4,
preoperative neurosurgical status was not significantly related to duration
of survival. Correlation of the radiological, operative and pathological
finding has led to a useful list of prognostic criteria for high grade
astrocytomas. In our experience, reoperation should be performed whenever
it seems to be possible and should be followed by a complete course
of radiotherapy. Radical surgery is the first step in treatment, followed
by irradiation and chemotherapy. The importance of detailed histological
diagnosis is stressed because of different biological behaviour with
regard to conventional and optimal therapy.
The role of surgery
to obtain a tissue diagnosis and to decompress mass effect in high grade
supratentorial glioma - astrocytoma in adult is a straightforward issue,
whereas oncological significance of aggressive tumor resection has been
more difficult to access.
76 patients with recurrent astrocytoma gr. III and IV were operated in neurosurgical Department from January 1996 to December 2000. Median age of the patients was 41 years. Gender rate man: women were 2,5:1. Most frequent localization was frontal and temporal lobes. The patients were presented with signs and symptoms of increased intracranial pressure, new onset of drug resistant seizures, progression of neurological symptoms and changes in mentation
Patients operated on for recurrent astrocytoma during 1996-2000.
72% patients had
astrocytoma gr. III and 28% had astrocytoma gr. IV.
In 38 out of 76
cases surgicaly resection was grossly total, 32 cases was subtotal.
Stereotactic biopsy was performed in 6 cases in tumors located in basal
ganglia an eloquent area.
Extensity of resection is defined:
Time interval between first operation and reoperation was 2 month to 2 years. Operative mortality during 1 week was in 6 cases (8%). After reoperation our patients were followed-up a period running from 2 to 6 month and during this period completed a new course of radiotherapy.
Outcome results in patients operated on for recurrent supratentorial astrocytomas during 1996-2000.
Postoperative complications were:
Patients with malignant
gliomas had poor prognosis despite of vigorous multimodality treatment.
Advanced age is associated with a less favorable response to radiation
therapy for GBM.
Generally the reasons for extraordinarily long survival in patients with GBM may be:
When a complete
resection (as much tumor as possible) was made, longer survival and
better quality of life can be achieved. ( Ammirati; Ciric; Frankel;
Weir; Laws etc.).
Other authors suggest only biopsy for diagnosis verification to be performed. Punt J. et all.)
In our department
we performed maximum radical operation followed by radiation therapy.
That doesn't mean complete excision of the tumor. There are limiting
factors mentioned above, such as: deep brain localization, eloquent
area, and poor patient condition.
Enlarging, enchasing masses in early postoperative imaging is sign of active progression of the tumor. In differential diagnosis radiation necrosis is present.
According to our experience most important factors determining outcome and length of survival are:
These were also our selection criteria for reoperation for recurent high grade astrocytomas. In our experience reoperation should be performed whenever it seems to be possible and should be followed by a complete course of radiotherapy.
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