Objective

Implantation of biodegradable Carmustine wafers in patients with malignant glioma is not generally recommended when the ventricular system is opened during tumor resection. Thrombin/fibrinogenn-covered collagen fleeces showed promising results in sufficiently closing ventricular defects. The aim of this study was to evaluate the postoperative morbidity in patients with implanted Carmustine wafers either with opened or intact ventricular system.

Methods

A consecutive series of patients who underwent resection of malignant glioma with implantation of Carmustine wafers was analyzed. In case of opening of the ventricular system, the defect in the ventricle wall was sealed using a collagen sponge coated with fibrinogen and thrombin prior to the implantation of the wafers. Postoperative adverse events (AE) and Karnofsky performance status scale (KPS) at follow up were compared between both groups.

Results

Fifty-four patients were included. The ventricular system was opened in 33 patients and remained intact in 21 patients. Both groups were comparable in terms of age, rate of primary and recurrent glioma, preoperative KPS, rate of gross total resection and number of implanted wafers. Postoperative AEs occurred in 9/33 patients (27.3%) with opened and in 5/21 patients (23.8%) with intact ventricular system (p = 0.13). At follow-up assessments, KPS was not significantly different between both groups (p = 0.18). Opened ventricular system was not associated with a higher incidence of postoperative AEs (p = 0.98).

Conclusion

Appropriate closure of opened ventricular system during resection of malignant glioma allows for a safe implantation of Carmustine wafers and is not associated with a higher incidence of postoperative AEs.

中文翻译：

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切除恶性胶质瘤后植入卡莫司汀晶片，打开或不打开心室系统

客观的

在肿瘤切除术中打开心室系统时，通常不推荐在恶性胶质瘤患者中植入可生物降解的卡莫司汀晶片。凝血酶/纤维蛋白原覆盖的胶原纤维在充分闭合心室缺损方面显示出有希望的结果。本研究的目的是评估植入卡莫司汀晶片且心室系统打开或完整的患者的术后发病率。

方法

连续分析了一系列接受卡莫司汀晶片植入手术切除恶性胶质瘤的患者。在打开心室系统的情况下，在植入晶片之前，使用涂有纤维蛋白原和凝血酶的胶原海绵密封心室壁中的缺损。比较两组的术后不良事件（AE）和随访时的卡诺夫斯基体能状态量表（KPS）。

结果

包括 54 名患者。33 名患者的心室系统被打开，21 名患者的心室系统保持完整。两组在年龄、原发性和复发性胶质瘤发生率、术前 KPS、总切除率和植入晶片数量方面具有可比性。术后 AE 发生在 9/33 (27.3%) 的开放患者和 5/21 (23.8%) 的完整心室系统患者 ( p  = 0.13)。在后续评估中，两组之间的 KPS 没有显着差异（p  = 0.18）。打开心室系统与术后 AE 的发生率较高无关 ( p  = 0.98)。

结论

在切除恶性神经胶质瘤期间适当关闭打开的心室系统可以安全植入卡莫司汀晶片，并且不会增加术后 AE 的发生率。