El Rahal Amir, Cipriani Debora, Fung Christian, Hohenhaus Marc, Sveikata Lukas, Straehle Jakob, Shah Mukesch Johannes, Heiland Henrik Dieter, Beck Jürgen, Schnell Oliver
Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
Department of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
Front Oncol. 2022 Feb 9;12:796105. doi: 10.3389/fonc.2022.796105. eCollection 2022.
Glioblastoma is the most common and the most challenging to treat adult primary central nervous system tumor. Although modern management strategies modestly improved the overall survival, the prognosis remains dismal associated with poor life quality and the clinical course often dotted by treatment side effects and cognitive decline. Functional deterioration might be caused by obstructive or communicating hydrocephalus but due to poor overall prognosis surgical treatment options are often limited and its optimal management strategies remain elusive. We aimed to investigate risk factors, treatment options and outcomes for tumor-associated hydrocephalus in a contemporary 10 years cohort of glioblastoma patients.
We reviewed electronic health records of 1800 glioblastoma patients operated at the Department of Neurosurgery, Medical Center - University of Freiburg from 2009 to 2019. Demographics, clinical characteristics and radiological features were analyzed. Univariate analysis for nominal variables was performed either by Fisher's exact test or Chi-square test, as appropriate.
We identified 39 glioblastoma patients with symptomatic communicating hydrocephalus treated by ventricular shunting (incidence 2.1%). Opening of the ventricular system during a previous tumor resection was associated with symptomatic hydrocephalus (p<0.05). There was also a trend toward location (frontal and temporal) and larger tumor volume. Number of craniotomies before shunting was not considered as a risk factor. Shunting improved hydrocephalus symptoms in 95% of the patients and Karnofsky Performance Score (KPS) could be restored after shunting. Of note, 75% of the patients had a post-shunting oncological treatment such as radiotherapy or chemotherapy, most prevalently chemotherapy. Infection (7.7%) and over- or under drainage (17.9%) were the most common complications requiring shunt revision in ten patients (25.6%), No peritoneal metastasis was found. The median overall survival (OS) was 385 days and the median post shunting survival was 135 days.
Ventricular system opening was identified as a risk factor for communicating hydrocephalus in glioblastoma patients. Although glioblastoma treatment remains challenging, shunting improved hydrocephalus-related functional status and may be considered even in a palliative setting for symptom relief.
胶质母细胞瘤是最常见且治疗最具挑战性的成人原发性中枢神经系统肿瘤。尽管现代管理策略适度提高了总生存期，但预后仍然不佳，生活质量差，临床病程常被治疗副作用和认知功能下降所困扰。功能恶化可能由梗阻性或交通性脑积水引起，但由于总体预后较差，手术治疗选择往往有限，其最佳管理策略仍不明确。我们旨在调查当代10年胶质母细胞瘤患者队列中肿瘤相关性脑积水的危险因素、治疗选择和结局。
我们回顾了2009年至2019年在弗莱堡大学医学中心神经外科接受手术的1800例胶质母细胞瘤患者的电子健康记录。分析了人口统计学、临床特征和放射学特征。对名义变量进行单因素分析时，酌情采用Fisher精确检验或卡方检验。
我们确定了39例接受脑室分流术治疗的有症状交通性脑积水的胶质母细胞瘤患者（发生率2.1%）。先前肿瘤切除术中脑室系统开放与有症状脑积水相关（p<0.05）。在位置（额叶和颞叶）和肿瘤体积较大方面也存在趋势。分流术前开颅手术次数未被视为危险因素。分流术使95%的患者脑积水症状得到改善，分流术后卡氏功能状态评分（KPS）得以恢复。值得注意的是，75%的患者在分流术后接受了肿瘤治疗，如放疗或化疗，最常见的是化疗。感染（7.7%）和引流过度或不足（17.9%）是10例患者（25.6%）最常见的需要分流术修正的并发症，未发现腹膜转移。中位总生存期（OS）为385天，分流术后中位生存期为135天。
脑室系统开放被确定为胶质母细胞瘤患者交通性脑积水的危险因素。尽管胶质母细胞瘤的治疗仍然具有挑战性，但分流术改善了与脑积水相关的功能状态，甚至在姑息治疗中为缓解症状也可考虑采用。
