Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project
Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project
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DOI：
10.3171/jns.2003.98.6.1175
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发表时间：
2003-06-01
影响因子：
4.1
通讯作者：
Berger, M
中科院分区：
文献类型：
--
作者：
Chang, SM;Parney, IF;Berger, M
Object.在许多新的恶性胶质瘤患者的临床试验中，手术干预作为肿瘤定向间质治疗（如基因治疗、生物可降解晶片植入和免疫治疗）的组成部分被纳入。毒性评估是评价这些新的治疗干预措施的主要组成部分，但这必须根据已知的并发症发生率开颅肿瘤切除术。预测神经系统结局的因素也将有助于选择手术为基础的临床试验的患者。胶质瘤结局项目是一个前瞻性汇编的数据库，包含788例恶性胶质瘤患者的信息，这些信息捕获了临床实践模式和患者结局。在这个系列中，分别分析了接受第一次或第二次开颅手术的患者的症状、肿瘤和患者特征以及围手术期并发症。对术前和术中可能影响神经功能预后的因素进行了评估，其中408例患者接受了首次手术（C1组），91例患者接受了第二次手术（C2组）。两组具有相似的患者和肿瘤特征，除了他们的中位年龄（C1组为55岁，C2组为50岁; p = 0.006）。头痛在C1组中更常见，而视神经乳头水肿和意识水平改变在接受二次手术的患者中更常见。C1组24%的患者和C2组33%的患者发生围手术期并发症（p = 0.1）。大多数患者在术后神经功能相同或更好，但C2组（18%）的患者比C1组（8%; p = 0.007）的患者表现出更差的神经功能状态。在C2组患者中，Karnofsky行为量表评分和肿瘤大小是重要的神经系统结局预测因子。两组的局部并发症发生率相似。C2组中全身感染发生率更高（4.4%比0%; p < 0.0001），抑郁发生率也更高（20%比11%; p = 0.02）。C1组的围手术期死亡率为1.5%，C2组为2.2%（p =无显著性）。各组平均住院时间为4 d。恶性胶质瘤二次开颅手术的围手术期并发症发生率略高于一次开颅手术。在评价需要开颅手术的术中局部治疗的毒性时，应考虑这一点。尽管如此，大多数患者在第一次或第二次开颅手术后神经功能稳定或改善。该数据集可作为神经外科医生和其他人讨论恶性胶质瘤患者手术风险的基准。
Object. In many new clinical trials of patients with malignant gliomas surgical intervention is incorporated as an integral part of tumor-directed interstitial therapies such as gene therapy, biodegradable wafer placement, and immunotherapy. Assessment of toxicity is a major component of evaluating these novel therapeutic interventions, but this must be done in light of known complication rates of craniotomy for tumor resection. Factors predicting neurological outcome would also be helpful for patient selection for surgically based clinical trials.Methods. The Glioma Outcome Project is a prospectively compiled database containing information on 788 patients with malignant gliomas that captured clinical practice patterns and patient outcomes. Patients in this series who underwent their first or second craniotomy were analyzed separately for presenting symptoms, tumor and patient characteristics, and perioperative complications. Preoperative and intraoperative factors possibly related to neurological outcome were evaluated.There were 408 patients who underwent first cramotomies (C1 group) and 91 patients who underwent second ones (C2 group). Both groups had similar patient and tumor characteristics except for their median age (55 years in the C I group compared with 50 years in the C2 group; p = 0.006). Headache was more common at presentation in the C1 group, whereas papilledema and an altered level of consciousness were more common at presentation in patients undergoing second surgeries. Perioperative complications occurred in 24% of patients in the C1 group and 33% of patients in the C2 group (p = 0.1). Most patients were the same or better neurologically after surgery, but more patients in the C2 group (18%) displayed a worsened neurological status than those in the C1 group (8%; p = 0.007). The Karnofsky Performance Scale score and, in patients in the C2 group, tumor size were important neurological outcome predictors. Regional complications occurred at similar rates in both groups. Systemic infections occurred more frequently in the C2 group (4.4 compared with 0%; p < 0.0001) as did depression (20 compared with 11%; p = 0.02). The perioperative mortality rate was 1.5% for the C1 group and 2.2% for the C2 group (p = not significant). The median length of the hospital stay was 4 days in each group.Conclusions. Perioperative complications occur slightly more often following a second craniotomy for malignant glioma than after the first craniotomy. This should be considered when evaluating toxicities from intraoperative local therapies requiring craniotomy. Nevertheless, most patients are neurologically stable or improved after either their first or second craniotomy. This data set may serve as a benchmark for neurosurgeons and others in a discussion of operative risks in patients with malignant gliomas.