Matea Rados

Background: Postoperative ischemia is a known complication of glioma resection that is registered by diffusion-weighted MRI (DWI) and can lead to new neurological deficits. The aim of this review was to assess the incidence of ischemia after glioma resection and identify potential risk factors and consequences. Methods: A systematic review was conducted according to the PRISMA guidelines. Cohort studies reporting surgeries for WHO grade II-IV gliomas followed by postoperative DWI within 72 h were included. Pooled, weighted incidences for postoperative ischemia and neurological deficits were calculated with a binary random-effects model. Results: In total, 29 studies were included in this review, of which 25 studies with 2729 cases were included for meta-analysis. Pooled incidence was 48% (95% confidence interval [CI]: 36%-59%) for postoperative ischemia and 32% (95% CI: 23%-41%) for postoperative transient and persistent neurological deficits. Postoperative ischemia with any neurological deficits occurred in 15% (95% CI: 10%-20%) of patients, postoperative ischemia without neurological sequelae in 26% (95% CI: 17%-35%), and 41% (95% CI: 30%-52%) of patients with postoperative ischemia experienced neurological deterioration. Postoperative ischemia was associated with opercular, insular, or temporal tumor locations, proximity to and infiltration of perforating arteries, prior radiotherapy, age and intraoperative hemodynamic decline, among others. Postoperative ischemia was related to neurological deterioration, recurrence, and overall survival in some studies. Conclusion: Postoperative ischemia is a quite frequent complication of glioma resection affecting functional outcome and disease progression. Potential risk factors may give insight in preventive measures and future studies with precise spatial analyses could identify vulnerable brain regions.

Objective: Children with refractory focal epilepsy differ from adults, although many centers will offer invasive electroencephalography (iEEG) to both. Outcomes in terms of likelihood of resection and subsequent seizure outcome after either subdural grid electrode implantation (SDE) or stereoelectroencephalography (SEEG) have, however, not been directly compared between age groups.Methods: We retrospectively included adults and children undergoing iEEG monitoring at four European centers. We compared the two age groups and techniques regarding complication rate, chance of proceeding to resection, and seizure freedom.Results: In total, 857 individuals were included (447 SEEG, 410 SDE; 572 adults, 285 children). Adults more often had a history of focal to bilateral tonic–clonic seizures (FBTCS) and prior epilepsy surgery and were more often magnetic resonance imaging‐negative. Children had a higher seizure frequency and rate of preexisting neurologic deficits. In SEEG, likelihood of resection was 64% in adults and 76% in children (p < .05), but chance of seizure freedom did not differ. Adults and children had similar chances of resection and seizure freedom rates after SDE. In children, postoperative seizure freedom was less likely after SDE than SEEG. In adults, history of FBTCS was associated with lower chance of seizure freedom. Overall complication rate was higher in children (22% vs. adults 15%) and in SDE (29% vs. SEEG 7%).Significance: Either iEEG technique provides an equally valid but very different road to success, with no difference in seizure outcome between the two age groups, but with higher risk of complications in SDE. We found similar surgical results for dissimilar techniques and a higher threshold for children. In case of an assumed lower chance of focality of epilepsy or chance of seizure freedom after resection, adults were more often explored with iEEG, whereas children were more severely affected when considered for iEEG.

BACKGROUND: Postoperative ischemia can lead to neurological deficits and is a known complication of glioma resection. There is inconsistency in documented incidence of ischemia after glioma resection, and the precise cause of ischemia is often unknown. OBJECTIVE: To assess the incidence of postoperative ischemia and neurological deficits after glioma resection and to evaluate their association with potential risk factors. METHODS: One hundred thirty-nine patients with 144 surgeries between January 2012 and September 2014 for World Health Organization (WHO) 2016 grade II-IV diffuse supratentorial gliomas with postoperative MRI within 72 hours were retrospectively included. Patient, tumor, and perioperative data were extracted from the electronic patient records. Occurrence of postoperative confluent ischemia, defined as new confluent areas of diffusion restriction, and new or worsened neurological deficits were analyzed univariably and multivariably using logistic regression models. RESULTS: Postoperative confluent ischemia was found in 64.6% of the cases. Occurrence of confluent ischemia was associated with an insular location (P = .042) and intraoperative administration of vasopressors (P = .024) in multivariable analysis. Glioma location in the temporal lobe was related to an absence of confluent ischemia (P = .01). Any new or worsened neurological deficits occurred in 30.6% and 20.9% at discharge from the hospital and at first follow-up, respectively. Occurrence of ischemia was significantly associated with the presence of novel neurological deficits at discharge (P = .013) and after 3 months (P = .024). CONCLUSION: Postoperative ischemia and neurological deficit were significantly correlated. Intraoperative administration of vasopressors, insular glioma involvement, and absence of temporal lobe involvement were significantly associated with postoperative ischemia.