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Meta-Analysis
. 2022 Feb;164(2):405-417.
doi: 10.1007/s00701-021-05067-9. Epub 2021 Dec 30.

Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

Ramin A Morshed #  1 , Jacob S Young #  1 , Andrew J Gogos  1 , Alexander F Haddad  2 , James T McMahon  3 , Annette M Molinaro  1 , Vivek Sudhakar  4 , Nadeem Al-Adli  5 , Shawn L Hervey-Jumper  1 , Mitchel S Berger  6
Affiliations
Meta-Analysis

Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

Ramin A Morshed et al. Acta Neurochir (Wien). 2022 Feb.

Abstract

Background: There is a concern that glioma patients undergoing repeat craniotomies are more prone to complications. The study's goal was to assess if the complication profiles for initial and repeat craniotomies were similar, to determine predictors of complications, and to compare results with those in the literature.

Methods: A retrospective study was conducted of glioma patients (WHO grade II-IV) who underwent either an initial or repeat craniotomy performed by the senior author from 2012 until 2019. Complications were recorded by discharge, 30 days, and 90 days postoperatively. New neurologic deficits were recorded by 90 days postoperatively. Multivariate regression was performed to identify factors associated with complications. A meta-analysis was performed to identify rates of complications based on number of prior craniotomies.

Results: Within the cohort of 714 patients, 400 (56%) had no prior craniotomies, 218 (30.5%) had undergone 1 prior craniotomy, and 96 (13.5%) had undergone ≥ 2 prior craniotomies. There were 27 surgical and 10 medical complications in 30 patients (4.2%) and 19 reoperations for complications in 19 patients (2.7%) with no deaths by 90 days. Complications, reoperation rates, and new neurologic deficits did not differ based on number of prior craniotomies. On multivariate analysis, older age (OR1.5, 95%CI 1.0-2.2) and significant leukocytosis due to steroid use (OR12.6, 95%CI 2.5-62.9) were predictors of complications. Complication rates in the cohort were lower than rates reported in the literature.

Conclusion: Contrary to prior reports in the literature, repeat craniotomies can be as safe as initial operations if surgeons implement best practices.

Keywords: Complications; Glioma; Recurrence; Surgical resection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Technical considerations for approaching glioma recurrence. a The skin incision for a repeat craniotomy may not overly the area of tumor recurrence. If the exposure needs to be adjusted, then a perpendicular incision (a “T” incision) is used to extend the skin opening. b A bone flap that has not fused to the surrounding cranium may be removed and elevated. However, if the prior bone flap has fused to the calvarium, then the craniotomy can be tailored within the prior flap to expose the focus of recurrence. c The cortex tends to be most adherent to the dura under the prior suture line, and a new dural flap may be within the prior dural opening. If necessary, a leg of the prior suture can be crossed to obtain the necessary cortical exposure. d Mapping for glioma recurrence must be tailored to tumor location. A combination of cortical and subcortical mapping can be performed to allow for safe resection. Previously positive mapping sites at first surgery may not be positive at the time of repeat craniotomy given the ability of neighboring cortical regions to assimilate function
Fig. 2
Fig. 2
Forest plot analysis of overall complication rate by number of prior craniotomies
Fig. 3
Fig. 3
Forest plot analysis of specific complications including intracranial hemorrhage, SSI/wound dehiscence, CSF leak, and venous thromboembolism (VTE)
See this image and copyright information in PMC

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