Conf. Dr.

Mircea Gorgan
Copyright 2004

COMPLICATII SI SECHELE
TARDIVE DUPA
TRATAMENTUL
MULTIMODAL AL
GLIOAMELOR CEREBRALE

Conf. Dr. Mircea Gorgan

Copyright 2004

SPITALUL CLINIC DE URGENTA

BAGDASAR-ARSENI
BUCURESTI
GORGAN MIRCEA, MEDIC PRIMAR
NEUROCHIRURG, SEF LUCRARI UMF
BUCUR NARCISA MEDIC PRIMAR
NEUROCHIRURG
NEACSU ANGELA MEDIC PRIMAR
NEUROCHIRURG
LATA ALINA MEDIC REZIDENT
NEUROCHIRURG

Conf. Dr. Mircea Gorgan

Copyright 2004

SURGICAL TREATMENT OF
RECURRENT GLIOBLASTOMATHERAPEUTICAL OPTION
Ass. Prof.Gorgan Mircea MD, PhD Bucur Narcisa MD, Neacsu Angela MD
Margaritescu Otilia MD, Marinoaica Liviu MD
First Neurosurgical Clinic, Fourth Neurosurgical Department
Clinic Emergency Hospital Bagdasar-Arseni Bucharest

Abstract: The authors analyze 239 case series of patients with glioma operated between 1995-2001 by the same team in the Fourth
Neurosurgical Department of the Clinic Emergency Hospital Bagdasar-Arseni from Bucharest.135 cases were glioblastoma
patients and 30 of them supported at least one reoperation according to the next criteria: 1) the length of time of recurrence; 2) the
morphological characteristics of the recurrence, location of the recurrence in close proximity of the original tumor 3) the patients
age, performance status-Karnofski score, and associated diseases; 4) radiological recurrence prior to the clinical symptoms; 5)
radiological appearance of tumor necrosis or abcess; 6) the written option of the family and patient to accept surgery. Twenty-five
patients (83,33%) had one reoperation only and five (16,66%) had more than one reoperation for a total of 35 operative procedures
primarily directed at tumor removal (1,16 procedures per patient). Reoperation was used more frequently in males as rescue therapy
adding to a decompressive craniotomy. We used decompressive craniotomy in 17 patients (56,66%). Morbidity after reoperation was
5,71% with no mortality. The median survival for all 30 patients after the second operation was 9 months, and was age and location
dependent Patients under 40 years of age had a longer postoperative survival (median, 11 months) than patients over 40 (median, 6
months; p < .001). The median total survival calculated from the first operation was 23 months. The temporal location ensured a
longer survival and in five cases the patients arrived to a third decompression with a maximum survival of 30 months from the first
operation. Conclusion: no malignant glial tumor can be cured by surgical resection alone, the type and extent of surgery offered to a
patient should be considered in the context of other therapeutic options and should be consistent with the technical resources of the
physician and the psychosocial resources of the patient and family. In selected cases of recurrent glioblastoma, reoperation is
satisfactory alternative.
Key words: recurrent glioblastoma, surgical treatment, reoperation.

Conf. Dr. Mircea Gorgan

Copyright 2004

CAZUISTICA

239 CAZURI DE PACIENTI CU GLIOAME

OPERATE IN PERIOADA 1995-2001

135 DE CAZURI DE GLIOBLASTOAME

30 DE PACIENTI REOPERATI PENTRU

RECIDIVE DE GLIOBLASTOM

Conf. Dr. Mircea Gorgan

Copyright 2004
O
O
O
O
O
O

CRITERII DE
REINTERVENTIE

1) INTERVALUL DE TIMP PANA LA RECIDIVA

2) CARACTERISTICILE MORFOLOGICE ALE RECIDIVEI,
LOCALIZAREA IN VECINATATEA TUMORII ORIGINARE
3) VARSTA PACIENTULUI SI SCORUL KARNOFSKI
4) RECIDIVA RADIOLOGICA PREMERGATOARE
AGRAVARII CLINICE
5) CARACTERISTICILE RADIOLOGICE DE NECROZA
TUMORALA SAU ABCES
6) OPTIUNEA SCRISA A FAMILIEI SI PACIENTULUI
PENTRU TRATAMENT CHIRURGICAL.

Conf. Dr. Mircea Gorgan

Copyright 2004

ANALIZA CAZUISTICII

O
O

25 DE PACIENTI AU FOST REOPERATI O

SINGURA DATA, 5 OPERATI DE PESTE 2 SI 3 ORI
PENTRU RECIDIVE TUMORALE
MEDIA SUPRAVIETUIRII PENTRU TOTI CEI 30 DE
PACIENTI DUPA A DOUA OPERATIE A FOST DE
PESTE 9 LUNI- STRANS DEPENDENT DE VARSTA
SI LOCALIZARE
PACIENTII SUB 40 DE ANI AU AVUT MEDIA
SUPRAVIETUIRII DE 11 LUNI
PACIENTII PESTE 40 DE ANI AU AVUT MEDIA
SUPRAVIETUIRII DE 6 LUNI

Conf. Dr. Mircea Gorgan

Copyright 2004

ANALIZA CAZUISTICII

MEDIA SUPRAVIETUIRII DE LA PRIMA

INTERVENTIE, MOMENT IN CARE PACIENTUL A
URMAT SI TRATAMENT ONCOLOGIC ESTE DE 23
DE LUNI
ACEASTA PRELUNGIRE SEMNIFICATIVA A
SUPRAVIETUIRII PENTRU PACIENTII CU CEL
MAI AGRESIV TIP DE TUMORA CEREBRALA A
DUS LA CRESTEREA PROCENTULUI DE
COMPLICATII SI SECHELE TARDIVE
SECUNDARE TRATAMENTULUI MULTIMODAL.

Conf. Dr. Mircea Gorgan

Copyright 2004

ANALIZA CAZUISTICII

TEHNICA CHIRURGICALA PENTRU

ABLAREA UNEI TUMORI CEREBRALE
MALIGNE CU POTENTIAL MAJOR DE
RECIDIVA SI CARE VA URMA
TRATAMENT ONCOLOGIC, INCLUDE:
-INCIZII LARGI LA SCALP CU
METINEREA PEDICULILOR VASCULARI
SI CONSERVAREA TROFICITATII
-VOLETE LA CEL PUTIN 2,5 CM IN
INTERIORUL INCIZIEI TEGUMENTARE

Conf. Dr. Mircea Gorgan

Copyright 2004

TRATAMENTUL MULTIMODAL AL
GLIOAMELOR CEREBRALE PRESUPUNE:

O
O
O
O
O
O

CHIRURGIE
RADIOTERAPIE
CHIMIOTERAPIE
CONTROLUL APARITIEI EVENTUALEI
RECIDIVE
TRATAMENTUL CHIRURGICAL AL
RECIDIVEI
REEVALUAREA ONCOLOGICA

Conf. Dr. Mircea Gorgan

Copyright 2004

PRINCIPALELE COMPLICATII TARDIVE

POSTIRADIERE > 6 LUNI

1) LEZIUNI CUTANATE DE
RADIODERMITA URMATE DE
GRANULOAME DE FIR, SUPRAINFECTII
LOCALIZATE SI/SAU PROPAGATE
ULTERIOR SPRE PROFUNZIME
2) LEZIUNI ALE VOLETULUI OSOS DE LA
OSTERONECROZA ASEPTICA LA
SUPRAINFECTII, ULTERIOR CU
INTOLERANTA CRANIOPLASTIEI

Conf. Dr. Mircea Gorgan

Copyright 2004

PRINCIPALELE COMPLICATII TARDIVE

POSTIRADIERE > 6 LUNI

3) LEZIUNI CEREBRALE DE
LEUCOENCEFALOPATIE, GLIOZA,
RADIONECROZA CU EVOLUTIE
PSEUDOTUMORALA
4) TULBURARI PROGRESIVE PSIHICE, DE
COMPORTAMENT, ALTERARI
IREVERSIBILE ALE FUNCTIILOR
COGNITIVE

Conf. Dr. Mircea Gorgan

Copyright 2004

PRINCIPALELE COMPLICATII TARDIVE

POSTIRADIERE > 6 LUNI

5) IMGINI FALSE DE RECIDIVA

TUMORALA INTERPRETATE IN CONTEXT
PRIN LIPSA PET

6) ACCENTUAREA DEFICITELOR
NEUROLOGICE SI ALTERAREA
SCORULUI KARNOFSKI

Conf. Dr. Mircea Gorgan

Copyright 2004
RM,26 ANI, ASTROCITOM GR II

Conf. Dr. Mircea Gorgan

Copyright 2004

OPERAT(03.2001) IRADIAT, REOPERAT (04.2002),

DECEDAT PRIN COMPLICATII I (06.2002)

Conf. Dr. Mircea Gorgan

Copyright 2004

SV, 30 ANI, GLIOBLASTOM

Conf. Dr. Mircea Gorgan

Copyright 2004
OPERAT 1998, IRADIAT, RECIDIVAT

Conf. Dr. Mircea Gorgan

Copyright 2004

REOPERAT 1999, DECEDAT LA 18

LUNI DE LA PRIMA INTERVENTIE

Conf. Dr. Mircea Gorgan

Copyright 2004

MS,28 ANI, GLIOM CEREBELOS DREPT, OPERAT

IN ALT SERVICIU 1997, NEIRADIAT, RECIDIVAT,
REOPERAT 1998

Conf. Dr. Mircea Gorgan

Copyright 2004

IRADIAT 1998, 3 CURE CITOSTATICE, CECITATE

BILATERALA, HEMIPAREZA SI AFAZIE

Conf. Dr. Mircea Gorgan

Copyright 2004

SI, 32 ANI,OLIGOASTROCITOM
ANAPLAZIC, OPERAT IRADIAT 1999

Conf. Dr. Mircea Gorgan

Copyright 2004

RECIDIVAT, REOPERAT 2000, MULTIPLE

PROBLEME LA SCALP CARE AU
NECESITAT INTERNARI REPETATECONTROL 2004

Conf. Dr. Mircea Gorgan

Copyright 2004

DE, 42 DE ANI, ASTROCITOM GR II

OPERAT, IRADIAT 2000, NECROZA DE
VOLET, 2001

Conf. Dr. Mircea Gorgan

Copyright 2004

CRANIOPLASTIE NETOLERATA,
RECIDIVA REOPERATA 2003, DECEDATA
IANUARIE 2004

Conf. Dr. Mircea Gorgan

Copyright 2004

II, 45 ANI,ASTROCITOM GR II OPERAT

1994, IRADIAT

Conf. Dr. Mircea Gorgan

Copyright 2004
RECIDIVAT, REOPERAT 1997

Conf. Dr. Mircea Gorgan

Copyright 2004

RECIDIVAT, REOPERAT 1999 DUPA CURE

CITOSTATICE REPETATE, NECROZA
VOLETULUI, INSUFICIENTA HEPATICA SI
RENALA

Conf. Dr. Mircea Gorgan

Copyright 2004

INTOLERANTA LA CRANIOPLASTIE
DUPA O NOUA TENTATIVA DE REFACERE
A CRANIULUI

Conf. Dr. Mircea Gorgan

Copyright 2004

ASPECT IRM IN 2002 DUPA 8 ANI DE

TRATAMENTE REPETATE

Conf. Dr. Mircea Gorgan

Copyright 2004

IG, 39 DE ANI, OLIGODENDROGLIOM

ANAPLAZIC OPERAT DECEMBRIE 2001,
IRADIAT

Conf. Dr. Mircea Gorgan

Copyright 2004
CONTROL POSTOPERATOR

Conf. Dr. Mircea Gorgan

Copyright 2004

REOPERAT PENTRU GLIOZA

POSTIRADIERE CU MANIFESTARE
PSEUDOTUMORALA

Conf. Dr. Mircea Gorgan

Copyright 2004

BS, 48 ANI, GLIOBLASTOM OPERAT 2000,

IRADIAT, REOPERAT 2001

Conf. Dr. Mircea Gorgan

Copyright 2004

ASPECT TARDIV CU LEZIUNE

EMISFERICA POSTIRADIERE

Conf. Dr. Mircea Gorgan

Copyright 2004
O

CONCLUZII

1) IN SERIA DE CAZURI CU GLIOBLASTOAME

REOPERATE DUPA CURA ONCOLOGICA A
CAROR SUPRAVIETUIRE A FOST IN JUR DE 2
ANI, NU AM INREGISTRAT COMPLICATII SI
SECHELE MAJORE TARDIVE.
2) PACIENTII OPERATI PENTRU TUMORI
CEREBRALE MAI PUTIN AGRESIVE (LOW-GRADE
GLIOMA) SI CU SUPRAVIETUIRE
INDELUNGATA, PREZINTA MULT MAI
FRECVENT COMPLICATII POST IRADIERE
LOCALE SI GENERALE.

Conf. Dr. Mircea Gorgan

Copyright 2004

CONCLUZII

3) PACIENTII TINERI SUB 40 DE ANI, DEZVOLTA

MULT MAI FRECVENT LEZIUNI CEREBRALE
POST IRADIERE DECAT CEI PESTE 40 DE ANI.

4) RADIOTERAPIA CONVENTIONALA ACTUALA

NECESITA A FI INLOCUITA CU O METODA
FOCALA HIPERFRACTIONATA, CU SCOPUL DE
A DIMINUA LA MAXIM EFECTELE SECUNDARE
ASUPRA STRUCTURILOR NERVOASE.