Murai Satoshi, Ichikawa Tomotsugu, Kurozumi Kazuhiko, Shimazu Yosuke, Oka Tetsuo, Otani Yoshihiro, Shimizu Toshihiko, Date Isao
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
J Clin Neurosci. 2016 Nov;33:148-153. doi: 10.1016/j.jocn.2016.03.042. Epub 2016 Jul 21.
BCNU wafers are a form of interstitial chemotherapy that is expected to improve the survival of patients with malignant glioma. However, their adverse events, especially brain edema, sometimes cause significant clinical symptoms. In this study, we performed a volumetric analysis of brain edema after the implantation of BCNU wafers and reported on the clinical course, and exacerbation factors of brain edema. Twelve patients who underwent surgical resection of supratentorial malignant glioma and BCNU wafer implantation, were enrolled. Radiographic quantitative analysis was conducted and compared with a historical control. The volume change in brain edema was divided into three groups and correlation with clinical symptoms was then evaluated. Compared with the control group, the brain edema in the BCNU wafer implantation group was significantly prolonged after surgery. Radiographic volumetric analysis revealed an increase of more than 25% at any time after surgery in four patients (33%) and a reduction of less than 25%, 1month after surgery in three patients (25%). Grade 3 clinical deterioration related to brain edema occurred in two patients and Grade 2 in one patient. Univariate analysis revealed that the radiographic deterioration of brain edema had no correlation with age, sex, diagnosis, tumor grade, preoperative volume of brain edema and tumor, residual tumor volume, or number of BCNU wafers. Radiographic quantitative analysis of brain edema indicated that BCNU wafer implantation may induce the prolongation and enlargement of brain edema with or without neurological deterioration. Brain edema may be controlled by intensive perioperative treatment with diuretics and corticosteroids.
卡莫司汀晶片是一种间质化疗形式，有望提高恶性胶质瘤患者的生存率。然而，其不良事件，尤其是脑水肿，有时会引起明显的临床症状。在本研究中，我们对卡莫司汀晶片植入后脑水肿进行了体积分析，并报告了临床过程以及脑水肿的加重因素。纳入了12例行幕上恶性胶质瘤手术切除并植入卡莫司汀晶片的患者。进行了影像学定量分析，并与历史对照进行比较。将脑水肿的体积变化分为三组，然后评估其与临床症状的相关性。与对照组相比，卡莫司汀晶片植入组术后脑水肿持续时间明显延长。影像学体积分析显示，4例患者（33%）术后任何时间脑水肿增加超过25%，3例患者（25%）术后1个月脑水肿减少不到25%。2例患者出现与脑水肿相关的3级临床恶化，1例患者出现2级恶化。单因素分析显示，脑水肿的影像学恶化与年龄、性别、诊断、肿瘤分级、术前脑水肿和肿瘤体积、残留肿瘤体积或卡莫司汀晶片数量无关。脑水肿的影像学定量分析表明，卡莫司汀晶片植入可能会导致脑水肿延长和扩大，无论是否伴有神经功能恶化。围手术期强化使用利尿剂和皮质类固醇可能控制脑水肿。
