Matsuda Ryosuke, Maeoka Ryosuke, Morimoto Takayuki, Nakazawa Tsutomu, Tokuda Noriaki, Kotsugi Masashi, Takeshima Yasuhiro, Tamura Kentaro, Yamada Shuichi, Nishimura Fumihiko, Park Young-Soo, Nakagawa Ichiro
Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
Department of Neurosurgery, Nara City Hospital, Nara, Japan.
J Korean Neurosurg Soc. 2025 Jan;68(1):60-66. doi: 10.3340/jkns.2024.0030. Epub 2024 Aug 1.
To evaluate the effect of ventricular opening (VO) on recurrence patterns in patients with newly diagnosed glioblastoma (GBM) treated with bis-chloroethyl-nitrosourea (BCNU) wafer implantation.
This single-center retrospective study included 40 patients with newly diagnosed GBM who received BCNU wafer implantation after tumor resection between March 2013 and February 2022. The patients were categorized into two groups based on whether VO occurred during the GBM resection. While 18 patients had VO, 22 did not have VO. In cases with VO, the ventricular wall defect is closed with gelatin or oxidized regenerated cellulose and fibrin glue before BCNU wafer implantation. Recurrence patterns-classified as local, diffuse, distant, or multifocal-and time to recurrence were compared between patients with and without VO.
The median follow-up period for the entire cohort was 32.2 months (interquartile range, 16.7-38 months). Median survival time was comparable between patients with VO and patients without VO (38 vs. 26 months, p=0.53). Recurrence occurred in 31/40 patients (77.5%) in entire cohort. The incidence of recurrence was comparable between patients with VO and patients without VO (14 [77.8%] vs. 17 [77.3%], p=1.0). No significant differences were seen between the two groups in time to recurrence (p=0.59) or recurrence patterns (p=0.35).
Ventricular opening during surgery with BCNU wafer implantation does not seem to influence the recurrence patterns. Ventricular opening does not induce distant recurrence if appropriate ventricular closure is performed.
评估脑室开放（VO）对新诊断的胶质母细胞瘤（GBM）患者接受双氯乙基亚硝脲（BCNU）晶片植入治疗后复发模式的影响。
这项单中心回顾性研究纳入了40例新诊断的GBM患者，这些患者在2013年3月至2022年2月期间肿瘤切除后接受了BCNU晶片植入。根据GBM切除过程中是否发生VO将患者分为两组。18例患者发生了VO，22例未发生VO。在发生VO的病例中，在植入BCNU晶片之前，用明胶或氧化再生纤维素和纤维蛋白胶封闭脑室壁缺损。比较有VO和无VO患者之间的复发模式（分为局部、弥漫性、远处或多灶性）和复发时间。
整个队列的中位随访期为32.2个月（四分位间距，16.7 - 38个月）。有VO和无VO患者的中位生存时间相当（38个月对26个月，p = 0.53）。整个队列中31/40例患者（77.5%）出现复发。有VO和无VO患者的复发发生率相当（14例[77.8%]对17例[77.3%]，p = 1.0）。两组在复发时间（p = 0.59）或复发模式（p = 0.35）方面均未观察到显著差异。
在BCNU晶片植入手术期间的脑室开放似乎不会影响复发模式。如果进行适当的脑室封闭，脑室开放不会诱发远处复发。
