Time course of neurological deficits after surgery for primary brain tumours
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ORIGINAL ARTICLE - TUMOR - GLIOMA
Time course of neurological deficits after surgery for primary brain tumours Maria Zetterling 1
&
Kristin Elf 2 & Robert Semnic 3 & Francesco Latini 1 & Elisabeth Ronne Engström 1
Received: 4 November 2019 / Accepted: 21 May 2020 # The Author(s) 2020
Abstract 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. Keywords Brain tumour surgery . Postoperative neurological deficit . Complications . Time course
Introduction After surgery for primary brain tumours, it is not uncommon with a deterioration of the neurological function [6, 7, 21, 15]. In some cases, postoperative neurological deterioration is This article is part of the Topical Collection on Tumor - Glioma Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04425-3) contains supplementary material, which is available to authorized users. * Maria Zetterling [email protected]
expected due to either perioperative ischemic injury or surgery in eloquent areas with corresponding deficits or when a supplementary motor area (SMA) syndrome occurs after surgery in the premotor cortex [17]. However, the reason for the postoperative neurological decline is not always clear, and often, it is difficult to predict the course of the deteriorated function. In the
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