V.G. Mikhailyuk, V.F. Melkishev, Yu.A. Medvedev, V.E. Olyushin, L.N. Maslova
(Polenov Research Neurosurgical Institute, Saint Petersburg)
Glial tumors account for 45.6-58% of all primary cerebral neoplasms in adults. It is the most widespread pathology. Today only multimodality treatment with surgical removal, being a leading constituent, makes it possible to prolong survival and to improve life quality of this category of patients. However, a number of errors and complications, developing during treatment, remains rather high. According to medical literature, 25-35% of cases with cerebral gliomas develop complications after tumor removal. They prolong a period of rehabilitation, have a negative effect on life quality and a scheme of treatment and lead to fatal outcomes (14.3-15.4%).
The authors analyzed the results of surgical treatment of 481 cases with cerebral gliomas, operated in the Polenov Research Neurosurgical Institute in 1996-2003. Complications, which developed during the first 10 postoperative days, were watched in 168 of them (34.9%). Gliomas were located in brain hemispheres (54.3%), subcortical ganglia (14.1%), ventricles (12.3%), corpus callosum (11.6%), brain stem (3.8%), cerebellum (3.3%). Diffuse glioblastomatosis was present in 0.6% of cases. The complications were divided into regional and systemic. In their turn, regional complications were subdivided into groups, depending on a cause of general cerebral and regional neurological symptoms. Thrombosis and thromboembolisn formed a separate category. Regional complications were the most frequent phenomenon (32.1%) after tumor removal. They included traumatic lesions of functionally eloquent areas of the brain (14.8%), postoperative edema of brain tissue and a residual part of a tumor (9.9%) and hemorrhages (6.0%). Systemic complications were less frequent (14.8%). As a rule, they appeared, when a course of a postoperative period was aggravated by regional complications. Thrombosis and thromboembolism were watched in 1.1% of cases. Their development was reliably dependent on a clinical stage of the disease, resection efficacy and operation duration, which, in their turn, were conditioned by neoplasm localization. The authors failed to find out distinct clinical differential-diagnostic criteria of regional complications. It proved once again, that modern methods of visualization should be considered to be the main way of their diagnosis. However, the analysis of a term of development, risk factors and peculiarities of a clinical course of some complications allowed to elaborate diagnostic algorithms. They helped to ascertain a cause of deterioration of a patientís state, when use of objective methods of examination was impossible.
Postoperative complications were more frequent in cases with gliomas of subcortical ganglia. They were characterized by a severe course and led to poorer results of treatment. A course of hemorrhagic complications in ventricular neoplasms, as well as of postoperative edema in corpus callosum tumors, was severe too. The most favorable course of a postoperative period was observed in cases with gliomas of cerebellum and hemispheres.
Improvement of diagnostic methods and surgical technique, better anesthesiologic support and more effective postoperative treatment reduced the rate of complications after removal of cerebral gliomas by 25% and led to at least twofold decrease of postoperative mortality.