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Implantation of Carmustine wafers after resection of malignant glioma with and without opening of the ventricular system

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Abstract

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.

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Funding

The authors received no funding or financial support for the research, authorship or publication of this article.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Goettingen, University Hospital Göttingen, Georg-August-University, Goettingen, Germany

    Christoph Bettag, Abdelhalim Hussein, Alexandra Sachkova, Hans Christoph Bock, Dorothee Mielke, Veit Rohde & Tammam Abboud

Authors
  1. Christoph Bettag
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  2. Abdelhalim Hussein
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  3. Alexandra Sachkova
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  4. Hans Christoph Bock
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  5. Dorothee Mielke
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  6. Veit Rohde
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  7. Tammam Abboud
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Contributions

All aforementioned authors (CB, AH, AS, HCB, DM, VR, TA) are contributors to the present study in that they have contributed substantially to (A) conception or design, (B) acquisition or (C) interpretation of data. In addition, all contributors were involved in drafting and critically revising the manuscript for important intellectual content. Finally, all contributors agree to be held accountable for all aspects of this work.

Corresponding author

Correspondence to Tammam Abboud.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the local ethics committee (Application Number: 24/4/19).

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Informed consent was obtained from each patient included in this study.

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Bettag, C., Hussein, A., Sachkova, A. et al. Implantation of Carmustine wafers after resection of malignant glioma with and without opening of the ventricular system. J Neurooncol 153, 519–525 (2021). https://doi.org/10.1007/s11060-021-03792-w

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  • DOI: https://doi.org/10.1007/s11060-021-03792-w

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