Johnstad Claes, Reinertsen Ingerid, Bouget David, Sagberg Lisa M, Strand Per S, Solheim Ole
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Health Research, SINTEF Digital, Trondheim, Norway.
Brain Spine. 2024 Apr 26;4:102818. doi: 10.1016/j.bas.2024.102818. eCollection 2024.
Postoperative hematomas that require reoperation are a serious, but uncommon complication to glioma surgery. However, smaller blood volumes are frequently observed, but their clinical significance is less known.
What are the incidence rates, risk factors, and patient-reported outcomes of all measurable blood in or near the resection cavity on postoperative MRI in diffuse glioma patients?
We manually segmented intradural and extradural blood from early postoperative MRI of 292 diffuse glioma resections. Potential associations between blood volume and tumor characteristics, demographics, and perioperative factors were explored using non-parametric methods. The assessed outcomes were generic and disease-specific patient-reported HRQoL.
Out of the 292 MRI scans included, 184 (63%) had intradural blood, and 212 (73%) had extradural blood in or near the resection cavity. The median blood volumes were 0.4 mL and 3.0 mL, respectively. Intradural blood volume was associated with tumor volume, intraoperative blood loss, and EOR. Extradural blood volume was associated with age and tumor volume. Greater intradural blood volume was associated with less headache and cognitive improvement, but not after adjustments for tumor volume.
Postoperative blood on early postoperative MRI is common. Intradural blood volumes tend to be larger in patients with larger tumors, more intraoperative blood loss, or undergoing subtotal resections. Extradural blood volumes tend to be larger in younger patients with larger tumors. Postoperative blood in or near the resection cavity that does not require reoperation does not seem to affect HRQoL in diffuse glioma patients.
需要再次手术的术后血肿是胶质瘤手术中一种严重但不常见的并发症。然而，较小的出血量经常被观察到，但其临床意义却鲜为人知。
弥漫性胶质瘤患者术后MRI显示切除腔内或其附近所有可测量血液的发生率、危险因素及患者报告的结果是什么？
我们从292例弥漫性胶质瘤切除术的术后早期MRI中手动分割硬膜内和硬膜外血液。使用非参数方法探讨出血量与肿瘤特征、人口统计学和围手术期因素之间的潜在关联。评估的结果是一般的和特定疾病的患者报告的健康相关生活质量。
在纳入的292次MRI扫描中，184例（63%）在切除腔内或其附近有硬膜内血液，212例（73%）有硬膜外血液。硬膜内和硬膜外出血量的中位数分别为0.4mL和3.0mL。硬膜内出血量与肿瘤体积、术中失血量和切除范围相关。硬膜外出血量与年龄和肿瘤体积相关。硬膜内出血量越大，头痛和认知改善越少，但在调整肿瘤体积后则不然。
术后早期MRI显示的术后出血很常见。肿瘤较大、术中失血量较多或接受次全切除的患者硬膜内出血量往往较大。肿瘤较大的年轻患者硬膜外出血量往往较大。切除腔内或其附近不需要再次手术的术后出血似乎不会影响弥漫性胶质瘤患者的健康相关生活质量。
