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  • Incidence of Leptomeningeal Disease Following Ventricular Entry During Resection of Supratentorial Grade IV Glioma

    Final Number:
    12

    Authors:
    Ben Allen Strickland MD; Dima Suki PhD; Rory R. Mayer MD; J Matthew Debnam MD; Ian E. McCutcheon MD; Raymond E. Sawaya MD; Jeffrey S. Weinberg MD

    Study Design:
    Other

    Subject Category:
    Tumor Section

    Meeting: 2016 Tumor Section Satellite Symposium

    Introduction: Advancements in glioma treatment options have extended survival allowing for a unique set of complications associated with disease progression to surface, one such complication being leptomeningeal disease (LMD). Several surgical risk factors have been previously described to increase the incidence of LMD, though most of the current literature is in regards to the metastatic tumor population. We hypothesized that ventricular entry during the resection of grade IV gliomas is a surgical risk factor for increasing the incidence of LMD.

    Methods: Patients with supratentorial grade IV glioma who underwent initial resection at The University of Texas MD Anderson Cancer Center between 1993 and 2013 were eligible for the study. Demographic data as well as details of surgical methodology, extent of resection, and incidence of LMD were obtained. Groups for comparison were divided into ventricular entry versus non-ventricular entry.

    Results: Inclusion criteria identified a total of 821 patients. In the case group of 344/821 patients with glioblastoma undergoing resection with ventricular entry, 8.1% (n=27) of patients developed LMD. In the control group of 477/821 patients having resection without ventricular entry, 1.5% (n=7) of patients developed LMD (p<0.001). The median duration from ventricular entry to diagnosis of LMD was 5.6 months (range, 0.5-28.9). The development of LMD was associated with significantly decreased survival (p<0.001).

    Conclusions: The risk of leptomeningeal disease is significantly increased with ventricular entry during resection of grade IV glioma. Recognition of these results suggest that neurosurgeons should be aware of ventricular entry during resection, and may take a less aggressive resection when in close proximity of the ventricular system as well as counseling patients of this possible unintended outcome.

    Patient Care: Patients with grade IV glioma need to be educated that ventricular entry is indeed a risk factor for LMD development. Similarly, neurosurgeons must weigh the risks and benefits of maximum safe resection versus subtotal resection if the tumor lines the ventricle.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize ventricular entry as a surgical risk factor for leptomeningeal disease 2) Understand the implications of maximum safe resection versus ventricular entry during the resection of grade IV gliomas

    References: 1. Ahn JH, Lee SH, Kim S, Joo J, Yoo H, Lee S, Shin S, Gwak H. Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location with mode of resection. J Neurosurg 116:984–993, 2012 2. Alatakis S, Malham GM, Thien C. Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review. Surg Neurol. 2001 Jul;56(1):33-7; discussion 37-8 3. Chowdary S and Chamberlain M. Leptomeningeal Metastases: Current Concepts and Management Guidelines. J Natl Compr Canc Netw 2005;3:693-703 4. Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection? J Neurosurg. 2015 Oct 23:1-12. 5. Marko NF, Weil RJ, Schroeder JL, Lang FF, Suki D, Sawaya RE. Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol. 2014 Mar 10;32(8):774-82.

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