Ventricular entry during resection of malignant gliomas: effect on intracranial cerebrospinal fluid tumor dissemination

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✓ The ventricular system is not infrequently entered during the course of maximum cytoreductive surgery for high-grade supratentorial gliomas. It is unclear if ventricular entry during surgery and/or proximity of the tumor to the ventricular system affects cerebrospinal fluid (CSF) tumor dissemination or the patients' overall survival rate. The authors retrospectively reviewed hospital records and neuroradiological studies of 51 patients operated on at the University of Washington between 1987 and 1991. Inclusion in this study necessitated a pathological diagnosis of malignant glioma and the availability of preoperative and postoperative computerized tomography scans or magnetic resonance images. Patients were excluded from the study if they had radiographic evidence of ventricular entry or CSF tumor dissemination prior to referral to the authors' institution. The index operation was defined as the first operation at the University of Washington or (in those patients with ventricular entry) the operation in which the ventricle was entered. Patients were followed until time of death or, in the case of survivors, until February, 1992. The effect of both ventricular entry and the proximity of the tumor to the ventricular system on CSF tumor dissemination and survival rate was assessed using statistical survival methodology.

There was no significant difference in time from diagnosis to the index operation between groups compared (Mann-Whitney U-test, p > 0.40). Cerebrospinal fluid dissemination was radiographically documented in 18 patients (35%) following the index operation. This occurrence was not significantly influenced by either ventricular entry during surgery (Mantel-Cox test, p = 0.13), the proximity of the tumor to the ventricular system (p = 0.63), or these two variables combined (p = 0.28). Survival rate following the index operation was not significantly affected by ventricular entry (p = 0.66), proximity of the tumor to the ventricular system (p = 0.61), or these two variable considered in combination (p = 0.44). However, survival rate was significantly decreased once CSF tumor dissemination had occurred (Cox model, p = 0.03).

Article Information

Address reprint requests to: Mitchel S. Berger, M.D., Department of Neurological Surgery, RI-20, University of Washington, 1959 N.E. Pacific Street, Seattle, Washington 98195.

© AANS, except where prohibited by US copyright law.

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    Magnetic resonance images demonstrating contiguous tumor and ventricular entry during surgery. Upper Left: T1-weighted axial image of a gadolinium-enhancing tumor in the right frontal lobe that is contiguous with the ventricle. Upper Right: Postoperative image confirming ventricular entry. Lower Left: Image revealing first evidence of subependymal dissemination 6 months following surgery with ventricular entry. Lower Right: Follow-up image 7 months postoperatively showing progressive subependymal disease.

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    Graphs showing cerebrospinal fluid (CSF) tumor dissemination. Kaplan-Meier curves demonstrate no significant effect on CSF tumor dissemination for ventricular entry during surgery (upper left), tumor location contiguous to the ventricular system (upper right), or combinations of ventricular entry and tumor contiguity (lower).

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    Graphs showing an analysis of the survival rate. Kaplan-Meier curves demonstrate no significant effect on survival rate for ventricular entry during surgery (upper left), tumor contiguity with the ventricular system (upper right), or combinations of ventricular entry and tumor contiguity (lower).

References

1.

Awad IBay JWRogers L: Leptomeningeal metastasis from supratentorial malignant gliomas. Neurosurgery 19:2472511986Awad I Bay JW Rogers L: Leptomeningeal metastasis from supratentorial malignant gliomas. Neurosurgery 19:247–251 1986

2.

Balhuizen JCBots GTAMSchaberg Aet al: Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system. J Neurosurg 48:7477531978Balhuizen JC Bots GTAM Schaberg A et al: Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system. J Neurosurg 48:747–753 1978

3.

Batzdorf UGold V: Dispersion of central nervous system tumors. Correlation between clinical aspects and tissue culture studies. J Neurosurg 41:6916981974Batzdorf U Gold V: Dispersion of central nervous system tumors. Correlation between clinical aspects and tissue culture studies. J Neurosurg 41:691–698 1974

4.

Bell WOPacker RJSeigel KRet al: Leptomeningeal spread of intramedullary spinal cord tumors. Report of three cases. J Neurosurg 69:2953001988Bell WO Packer RJ Seigel KR et al: Leptomeningeal spread of intramedullary spinal cord tumors. Report of three cases. J Neurosurg 69:295–300 1988

5.

Berger MSGhatan SGeyer JRet al: Seizure outcome in children with hemispheric tumors and associated intractable epilepsy: the role of tumor removal combined with seizure foci resection. Pediatr Neurosurg 17:1851911991/1992 Berger MS Ghatan S Geyer JR et al: Seizure outcome in children with hemispheric tumors and associated intractable epilepsy: the role of tumor removal combined with seizure foci resection. Pediatr Neurosurg 17:185–191 1991/1992

6.

Berger MSOjemann GA: Intraoperative brain mapping techniques in neurooncology. Stereotact Funct Neurosurg 58:1531611992Berger MS Ojemann GA: Intraoperative brain mapping techniques in neurooncology. Stereotact Funct Neurosurg 58:153–161 1992

7.

Berger MSOjemann GALettich E: Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1:65801990Berger MS Ojemann GA Lettich E: Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1:65–80 1990

8.

Byran P: CSF seeding of intra-cranial tumors: a study of 96 cases. Clin Radiol 25:3553601974Byran P: CSF seeding of intra-cranial tumors: a study of 96 cases. Clin Radiol 25:355–360 1974

9.

Cairns HRussell DS: Intracranial and spinal metastases in gliomas of the brain. Brain 54:3774201931Cairns H Russell DS: Intracranial and spinal metastases in gliomas of the brain. Brain 54:377–420 1931

10.

Choucair AKLevin VAGutin PHet al: Development of multiple lesions during radiation therapy and chemotherapy in patients with gliomas. J Neurosurg 65:6546581986Choucair AK Levin VA Gutin PH et al: Development of multiple lesions during radiation therapy and chemotherapy in patients with gliomas. J Neurosurg 65:654–658 1986

11.

Cohen ARWisoff JHAllen JCet al: Malignant astrocytomas of the spinal cord. J Neurosurg 70:50541989Cohen AR Wisoff JH Allen JC et al: Malignant astrocytomas of the spinal cord. J Neurosurg 70:50–54 1989

12.

Dropcho EJWisoff JHWalker RWet al: Supratentorial malignant gliomas in childhood: a review of fifty cases. Ann Neurol 22:3553641987Dropcho EJ Wisoff JH Walker RW et al: Supratentorial malignant gliomas in childhood: a review of fifty cases. Ann Neurol 22:355–364 1987

13.

Duong DHRostomily RCHaynor DRet al: Measurement of tumor resection volumes from computerized images. Technical note. J Neurosurg 77:1511541992Duong DH Rostomily RC Haynor DR et al: Measurement of tumor resection volumes from computerized images. Technical note. J Neurosurg 77:151–154 1992

14.

Eade OEUrich H: Metastasising gliomas in young subjects. J Pathol 103:2452561971Eade OE Urich H: Metastasising gliomas in young subjects. J Pathol 103:245–256 1971

15.

Erlich SSDavis RL: Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 42:285428641978Erlich SS Davis RL: Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 42:2854–2864 1978

16.

Glass JPMelamed MChernik NLet al: Malignant cells in cerebrospinal fluid (CSF): the meaning of a positive CSF cytology. Neurology 29:136913751979Glass JP Melamed M Chernik NL et al: Malignant cells in cerebrospinal fluid (CSF): the meaning of a positive CSF cytology. Neurology 29:1369–1375 1979

17.

Grabb PAAlbright ALPang D: Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 30:64711992Grabb PA Albright AL Pang D: Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 30:64–71 1992

18.

Heros DORenkens KKasdon DLet al: Patterns of recurrence in glioma patients after interstitial irradiation and chemotherapy: report of three cases. Neurosurgery 22:4744781988Heros DO Renkens K Kasdon DL et al: Patterns of recurrence in glioma patients after interstitial irradiation and chemotherapy: report of three cases. Neurosurgery 22:474–478 1988

19.

Hochberg FHPruitt A: Assumptions in the radiotherapy of glioblastoma. Neurology 30:9079111980Hochberg FH Pruitt A: Assumptions in the radiotherapy of glioblastoma. Neurology 30:907–911 1980

20.

Kandt RSShinnar SD'Souza BJet al: Cerebrospinal metastases in malignant childhood astrocytomas. J Neurooncol 2:1231281984Kandt RS Shinnar S D'Souza BJ et al: Cerebrospinal metastases in malignant childhood astrocytomas. J Neurooncol 2:123–128 1984

21.

Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481 1958

22.

Onda KTanaka RTakahashi Het al: Cerebral glioblastoma with cerebrospinal fluid dissemination: a clinicopathological study of 14 cases examined by complete autopsy. Neurosurgery 25:5335401989Onda K Tanaka R Takahashi H et al: Cerebral glioblastoma with cerebrospinal fluid dissemination: a clinicopathological study of 14 cases examined by complete autopsy. Neurosurgery 25:533–540 1989

23.

Onda KTanaka RTakahashi Het al: Symptomatic cerebrospinal fluid dissemination of cerebral glioblastoma. Computed tomographic findings in 11 cases. Neuroradiology 32:1461501990Onda K Tanaka R Takahashi H et al: Symptomatic cerebrospinal fluid dissemination of cerebral glioblastoma. Computed tomographic findings in 11 cases. Neuroradiology 32:146–150 1990

24.

Packer RJAllen JNielsen Set al: Brainstem glioma: clinical manifestations of meningeal gliomatosis. Ann Neurol 14:1771821983Packer RJ Allen J Nielsen S et al: Brainstem glioma: clinical manifestations of meningeal gliomatosis. Ann Neurol 14:177–182 1983

25.

Packer RJSiegel KRSutton LNet al: Leptomeningeal dissemination of primary central nervous system tumors of childhood. Ann Neurol 18:2172211985Packer RJ Siegel KR Sutton LN et al: Leptomeningeal dissemination of primary central nervous system tumors of childhood. Ann Neurol 18:217–221 1985

26.

Salazar OMRubin P: The spread of glioblastoma multiforme as a determining factor in the radiation treated volume. Int J Radiat Oncol Biol Phys 1:6276371976Salazar OM Rubin P: The spread of glioblastoma multiforme as a determining factor in the radiation treated volume. Int J Radiat Oncol Biol Phys 1:627–637 1976

27.

Vertosick FT JrSelker RG: Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical series. Neurosurgery 27:5165221990Vertosick FT Jr Selker RG: Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical series. Neurosurgery 27:516–522 1990

28.

Wagner JAFrost JKWisotzkey H Jr: Subarachnoid neoplasia: incidence and problems of diagnosis. South Med J 53:150315081960Wagner JA Frost JK Wisotzkey H Jr: Subarachnoid neoplasia: incidence and problems of diagnosis. South Med J 53:1503–1508 1960

29.

Wilkins RHOdom GL: Cytological changes in cerebrospinal fluid associated with resections of intracranial neoplasms. J Neurosurg 25:24341966Wilkins RH Odom GL: Cytological changes in cerebrospinal fluid associated with resections of intracranial neoplasms. J Neurosurg 25:24–34 1966

30.

Yung WAHorten BCShapiro WR: Meningeal gliomatosis: a review of 12 cases. Ann Neurol 8:6056081980Yung WA Horten BC Shapiro WR: Meningeal gliomatosis: a review of 12 cases. Ann Neurol 8:605–608 1980

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