Time course of neurological deficits after surgery for primary brain tumours

Abstract

Background: The postoperative course after surgery for primary brain tumours can be difficult to predict. We examined the time course of postoperative neurological deficits and analysed possible predisposing factors.

Method: Hundred adults with a radiological suspicion of low- or high-grade glioma were prospectively included and the postoperative course analysed. Possible predictors of postoperative neurological deterioration were evaluated.

Results: New postoperative neurologic deficits occurred in 37% of the patients, and in 4%, there were worsening of a preoperative deficit. In 78%, the deficits occurred directly after surgery. The probable cause of deterioration was EEG-verified seizures in 7, ischemic lesion in 5 and both in 1, resection of eloquent tissue in 6, resection close to eloquent tissue including SMA in 11 and postoperative haematoma in 1 patient. Seizures were the main cause of delayed neurological deterioration. Two-thirds of patients with postoperative deterioration showed complete regression of the deficits, and in 6% of all patients, there was a slight disturbance of the function after 3 months. Remaining deficits were found in 6% and only in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of postoperative neurological deterioration and preoperative neurological deficits of remaining deficits.

Conclusions: Postoperative neurological deficits occurred in 41% and remained in 6% of patients. Remaining deficits were found in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of neurological deterioration and preoperative neurological deficits of remaining deficits.

Keywords: Brain tumour surgery; Complications; Postoperative neurological deficit; Time course.

Fig. 1

Pre- and postoperative neurological deficits. Before surgery (left), 40 patients displayed neurological deficits of whom six patients had two deficits. After surgery (right), 37 patients showed new neurological deficits, and four patients exhibited worsening of a preoperative existing neurological deficits. In 13 of these patients, there were two deficits

Fig. 2

Occurrence and regression of postoperative neurological deficits in 41 patients. The left figure shows at what time after surgery neurological deficits occurred, and the right figure shows the time to regression of postoperative neurological deficits. No info = no information

Fig. 3

The number of patients with neurological deficits at different time points after surgery