EVALUATION AND SURGICAL OUTCOMES IN RECURRENT INTRACRANIAL GLIOMAS- A CASE SERIES

Dr. P. Anil Kumar Reddy (senior resident, Department of Neurosurgery, SVIMS Tirupati)
Dr.V.V.Ramesh Chandra (Professor & HOD) , Dr.B.C.M.Prasad (Senior Professor)

INTRODUCTION RESULTS & DISCUSSION

 Recurrent gliomas have a poor prognosis The median age was 40 years. There was a slight male preponderance (21 out of 36).
with recurrences being inevitable and choice The disease free interval ranged from 3 months to 11 years (median 25 months)
of therapies, extremely limited with higher About 9 patients (25%) didn’t take postoperative chemoradiation post initial surgery.
surgical morbidity of operating a previously The presentation features included seizures (10 ) , progressive neurological deficits (12) , raised
treated case. intracranial pressure (21).

AIMS / OBJECTIVES 42/F with recurrent anaplastic oligodendroglioma grade EXTENT OF RESECTION
3, operated 6 years ago, didn’t take chemoradiation. Now
Asses the immediate perioperative outcomes in operated for recurrence. Post operatively patient developed incomplete
patients with intracranial gliomas who left hemiplegia.
subtotal
underwent surgery at our center at the time of
recurrence near total
MATERIALS / METHODS Gross total excision
 Final histology revealed glioblastoma in 22 cases, diffuse/anaplastic astrocytoma in 9 cases,
Place of Study: Department of Neurosurgery, 0 2 4 6 8 10 12 14 16 18
Diffuse/Anaplastic Oligodendroglioma in 4 cases, and treatment-related changes in 1 case.
SVIMS, Tirupati
 No significant relationship between IDH mutant (17 cases) vs IDH wild variant (16 cases) in
36 patients of recurrent gliomas operated
incidence of recurrences.
from 2013-June 2023
 A larger proportion (36%, n=13) of recurrent gliomas showed improvement in neurological
The outcome measures assessed by
deficits post operatively after surgery for recurrence.
immediate post-op neurological status at
discharge, regional and systemic complications, Fig 2- 31/M with left anaplastic astrocytoma, operated 7
months ago, took chemoradiation. Now operated for
overall morbidity, perioperative mortality. recurrence. No post-operative deficits.
 EVALUATION AND SURGICAL OUTCOMES IN RECURRENT INTRACRANIAL GLIOMAS- A CASE SERIES
Dr. P. Anil Kumar Reddy (senior resident, Department of Neurosurgery, SVIMS Tirupati)
Dr.V.V.Ramesh Chandra (Professor & HOD) , Dr.B.C.M.Prasad (Senior Professor)

Histologic subtype N Mean

New onset neurological deficits or worsening of pre- Disease free
(Among operated Recurrent gliomas) (%) interval
existing neurological deficits occurred in 6 cases (17%)
Glioblastoma multiforme 22 11 months
(WHO grade 4) (61%)
Mortality occurred in 3 patients (8.3%). Out of which one Anaplastic Astrocytoma grade 3 3(8.3%) 25 months
patient died of Ventilator associated pneumonia, another of
Meningitis and the other due to postoperative Myocardial Anaplastic Oligodendroglioma grade 3 4 (11.1%) 48 months
infarction. Diffuse Astrocytoma grade 2 6 (16.7%) 71 months

Morbidity occurred in 8 patients (22%), , hemiparesis in 4, Pilocytic Astrocytoma grade 1 1 (2.8%) 96 months

and permanent cognitive decline in 2 patients, new onset

seizures in 1 patient Brocas Aphasia in 1 patient (GBM
involving left frontal region) 52/F with recurrent GBM grade 4 , operated 1 year ago,
took chemoradiation. Now operated for recurrence. Post
operatively patient had relief of symptoms
HPE- GBM IV CONCLUSION
Out of these patients of morbidity 6 patients (75%) didn’t
take prior chemoradiation, there is significant relationship Surgery for recurrent gliomas is possible with accepted mortality.
between prior chemoradiation and morbidity post resection Surgery provides symptomatic relief in a large cases.
of recurrences in gliomas. (P<0.05) Prior chemoradiation reduces morbidity after second surgery.
IDH mutation type has no significant relationship on recurrence.