Incidence and impact of stroke following surgery for low-grade gliomas

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OBJECTIVE

Ischemic complications are a common cause of neurological deficits following low-grade glioma (LGG) surgeries. In this study, the authors evaluated the incidence, risk factors, and long-term implications of intraoperative ischemic events.

METHODS

The authors retrospectively evaluated patients who had undergone resection of an LGG between 2013 and 2017. Analysis included pre- and postoperative demographic, clinical, radiological, and anesthetic data, as well as intraoperative neurophysiology data, overall survival, and functional and neurocognitive outcomes.

RESULTS

Among the 82 patients included in the study, postoperative diffusion-weighted imaging showed evidence of acute ischemic strokes in 19 patients (23%), 13 of whom (68%) developed new neurological deficits. Infarcts were more common in recurrent and insular surgeries (p < 0.05). Survival was similar between the patients with and without infarcts. Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced motor deficits (p = 0.024), decreasing to 16% (p = 0.082) and 37% (p = 0.024), respectively, at 1 year. Neurocognitive functions before and 3 months after surgery were generally stable for the two groups, with the exception of a decline in verbal rhyming ability among patients with infarcts. Confusion during awake craniotomy was a strong predictor of the occurrence of an ischemic stroke. Mean arterial pressure at the beginning of surgery was significantly lower in the infarct group.

CONCLUSIONS

Recurrent surgeries and insular tumor locations are risk factors for intraoperative strokes. Although they do not affect survival, these strokes negatively affect patient activity and performance status, mainly during the first 3 postoperative months, with gradual functional improvement over 1 year. Several intraoperative parameters may suggest the impending development of an infarct.

ABBREVIATIONS DWI = diffusion-weighted imaging; EOR = extent of resection; IOM = intraoperative monitoring; KPS = Karnofsky Performance Status; LGG = low-grade glioma; MAP = mean arterial pressure; MEP = motor evoked potential; mRS = modified Rankin Scale; Tc-MEP = transcortical MEP.
Article Information

Contributor Notes

Correspondence Rachel Grossman: Tel-Aviv Medical Center, Tel-Aviv, Israel. rachelgr@tasmc.health.gov.il.INCLUDE WHEN CITING Published online December 27, 2019; DOI: 10.3171/2019.10.JNS192301.

A.B. and G.T. share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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