Professional Documents
Culture Documents
Mircea Gorgan
Copyright 2004
COMPLICATII SI SECHELE
TARDIVE DUPA
TRATAMENTUL
MULTIMODAL AL
GLIOAMELOR CEREBRALE
SURGICAL TREATMENT OF
RECURRENT GLIOBLASTOMATHERAPEUTICAL OPTION
Ass. Prof.Gorgan Mircea MD, PhD Bucur Narcisa MD, Neacsu Angela MD
Margaritescu Otilia MD, Marinoaica Liviu MD
First Neurosurgical Clinic, Fourth Neurosurgical Department
Clinic Emergency Hospital Bagdasar-Arseni Bucharest
Abstract: The authors analyze 239 case series of patients with glioma operated between 1995-2001 by the same team in the Fourth
Neurosurgical Department of the Clinic Emergency Hospital Bagdasar-Arseni from Bucharest.135 cases were glioblastoma
patients and 30 of them supported at least one reoperation according to the next criteria: 1) the length of time of recurrence; 2) the
morphological characteristics of the recurrence, location of the recurrence in close proximity of the original tumor 3) the patients
age, performance status-Karnofski score, and associated diseases; 4) radiological recurrence prior to the clinical symptoms; 5)
radiological appearance of tumor necrosis or abcess; 6) the written option of the family and patient to accept surgery. Twenty-five
patients (83,33%) had one reoperation only and five (16,66%) had more than one reoperation for a total of 35 operative procedures
primarily directed at tumor removal (1,16 procedures per patient). Reoperation was used more frequently in males as rescue therapy
adding to a decompressive craniotomy. We used decompressive craniotomy in 17 patients (56,66%). Morbidity after reoperation was
5,71% with no mortality. The median survival for all 30 patients after the second operation was 9 months, and was age and location
dependent Patients under 40 years of age had a longer postoperative survival (median, 11 months) than patients over 40 (median, 6
months; p < .001). The median total survival calculated from the first operation was 23 months. The temporal location ensured a
longer survival and in five cases the patients arrived to a third decompression with a maximum survival of 30 months from the first
operation. Conclusion: no malignant glial tumor can be cured by surgical resection alone, the type and extent of surgery offered to a
patient should be considered in the context of other therapeutic options and should be consistent with the technical resources of the
physician and the psychosocial resources of the patient and family. In selected cases of recurrent glioblastoma, reoperation is
satisfactory alternative.
Key words: recurrent glioblastoma, surgical treatment, reoperation.
CAZUISTICA
CRITERII DE
REINTERVENTIE
ANALIZA CAZUISTICII
O
O
ANALIZA CAZUISTICII
ANALIZA CAZUISTICII
TRATAMENTUL MULTIMODAL AL
GLIOAMELOR CEREBRALE PRESUPUNE:
O
O
O
O
O
O
CHIRURGIE
RADIOTERAPIE
CHIMIOTERAPIE
CONTROLUL APARITIEI EVENTUALEI
RECIDIVE
TRATAMENTUL CHIRURGICAL AL
RECIDIVEI
REEVALUAREA ONCOLOGICA
1) LEZIUNI CUTANATE DE
RADIODERMITA URMATE DE
GRANULOAME DE FIR, SUPRAINFECTII
LOCALIZATE SI/SAU PROPAGATE
ULTERIOR SPRE PROFUNZIME
2) LEZIUNI ALE VOLETULUI OSOS DE LA
OSTERONECROZA ASEPTICA LA
SUPRAINFECTII, ULTERIOR CU
INTOLERANTA CRANIOPLASTIEI
3) LEZIUNI CEREBRALE DE
LEUCOENCEFALOPATIE, GLIOZA,
RADIONECROZA CU EVOLUTIE
PSEUDOTUMORALA
4) TULBURARI PROGRESIVE PSIHICE, DE
COMPORTAMENT, ALTERARI
IREVERSIBILE ALE FUNCTIILOR
COGNITIVE
6) ACCENTUAREA DEFICITELOR
NEUROLOGICE SI ALTERAREA
SCORULUI KARNOFSKI
SI, 32 ANI,OLIGOASTROCITOM
ANAPLAZIC, OPERAT IRADIAT 1999
CRANIOPLASTIE NETOLERATA,
RECIDIVA REOPERATA 2003, DECEDATA
IANUARIE 2004
INTOLERANTA LA CRANIOPLASTIE
DUPA O NOUA TENTATIVA DE REFACERE
A CRANIULUI
CONCLUZII
CONCLUZII