URGENT SURGICAL TREATMENT OF CEREBRAL NEOPLASM COMPLICATIONS Authors: Spasić Svetolik 1, Đurović Branko 1 1 Clinic for neurosurgery, Clinical Centre of Serbia, Dr Koste Todorovića 4, 11000 Belgrade, Serbia
Introduction • Compressive effect of the tumor and/or associated conditions - cerebral edema, intracranial hemorrhage and hydrocephalus • Increased intracranial pressure (ICP) – risk of brain herniation • Abrupt neurological deterioration – neurosurgical emergency • Neurosurgical management crucial for adequate brain decompression
Aim • The aim of this study was to define main indications for an emergency surgical treatment and to assess the effects of neurosurgical procedures GCS Neurological deficit Time Figure 1. Effects of time past prior to surgery on GCS (Glasgow Coma Score) and neurological deficit
Materials and methods • Retrospective analysis of 20 patients (age 16 -60) treated in the neurosurgical unit, Emergency Center Belgrade • Obtained data was based on patient history, neurological examination and imaging studies (CT scans – visualization of intracranial compressive effect of the tumor and/or associated complications) • Parameters observed – neurological deficit and Glasgow Coma Score (GCS) before and after surgical procedure • Initial hypothesis: hypothesis • main indication for a surgical procedure is a severe deterioration of consciousness (GCS ≤ 7) • Neurosurgical procedure – only effective course of treatment
Results Table 1. Frequency of cerebral neoplasm complications in patient population Conditions associated with brain tumors Hemorrhage Hydrocephalus Edema Mass effect 35% 30% 25% 10%
Results II • Neurosurgical procedures have shown significant positive effect on values of GCS in patients, since median value of GCS (med GCS) before surgery was 9 and 13 after surgery (Z=2, 4; p=0, 017) Chart 1. Effects of surgical treatment on median value of GCS in patient population
Results III • Patient population was divided into three groups, based on a degree of consciousness disorder: sever (group I) , moderate (group II) and mild (group III). Majority of patients treated were in the I group (45%), which was the group of particular interest Chart 2. Prevalence of patients with different degrees of consciousness disorder
Results IV • Neurosurgical procedure had most positive impact on patients with severe consciousness disorder (group I) (Z=2, 5; p=0. 011) Chart 3. Effects of surgical treatment on median value of GCS in groups of patients ( light shade – preoperative med GCS, dark shade – postoperative med GCS )
Results V • Surgery had positive effect on patients who presented with consciousness disorder and dysphasia (Chi-square=12, p<0, 001) * * p<0, 001 Chart 4. Effects of neurosurgical procedure on neurological symptoms in patient population (blue– incidence of neurological deficit before surgery, red – incidence of neurological deficit after surgery)
Results VI • High degree of positive correlation was shown between preoperative and postoperative GCS in patient population (r=0, 651; p=0, 007). High degree of positive correlation was established, between preoperative GCS, and postoperative GCS in patients with severe consciousness disorder (group I) Graph 1. Correlation of preoperative and postoperative GCS values in patient population
Conclusion • Two main indications were defined: • Severe deterioration of consciousness • Substantial compressive effect of the tumor and/or associated expansive process, visualized on CT scans • Defining indications promptly - one of the most important steps in neurosurgical treatment • Neurosurgical procedure is the only effective course of treatment of brain tumors causing tissue herniation and incarceration
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