Time course of neurological deficits after surgery for primary brain tumours

• Published in: Acta neurochirurgica 2020-12, Vol.162 (12), p.3005-3018
• Main Authors: Zetterling, Maria, Elf, Kristin, Semnic, Robert, Latini, Francesco, Engström, Elisabeth Ronne
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain cancer; Brain Neoplasms - surgery; Brain tumors; Brain tumour surgery; Complications; EEG; Female; Glioma; Glioma - surgery; Hematoma; Humans; Interventional Radiology; Ischemia; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurological diseases; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - adverse effects; Original - Tumor - Glioma; Original Article - Tumor - Glioma; Postoperative Complications - etiology; Postoperative neurological deficit; Postoperative Period; Seizures; Seizures - etiology; Surgery; Surgical Orthopedics; Time course; Time Factors; Tumor – Glioma; Tumors
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-020-04425-3

Background The postoperative course after surgery for primary brain tumours can be difficult to predict. We examined the time course of postoperative neurological deficits and analysed possible predisposing factors. Method Hundred adults with a radiological suspicion of low- or high-grade glioma were prospectively included and the postoperative course analysed. Possible predictors of postoperative neurological deterioration were evaluated. Results New postoperative neurologic deficits occurred in 37% of the patients, and in 4%, there were worsening of a preoperative deficit. In 78%, the deficits occurred directly after surgery. The probable cause of deterioration was EEG-verified seizures in 7, ischemic lesion in 5 and both in 1, resection of eloquent tissue in 6, resection close to eloquent tissue including SMA in 11 and postoperative haematoma in 1 patient. Seizures were the main cause of delayed neurological deterioration. Two-thirds of patients with postoperative deterioration showed complete regression of the deficits, and in 6% of all patients, there was a slight disturbance of the function after 3 months. Remaining deficits were found in 6% and only in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of postoperative neurological deterioration and preoperative neurological deficits of remaining deficits. Conclusions Postoperative neurological deficits occurred in 41% and remained in 6% of patients. Remaining deficits were found in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of neurological deterioration and preoperative neurological deficits of remaining deficits.